Individual
THERESA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2158 INTELLIPLEX DR STE 200, SHELBYVILLE, IN 46176-8549
(317) 398-2812
Mailing address
2158 INTELLIPLEX DR STE 200, SHELBYVILLE, IN 46176-8549
(317) 398-2812
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042231A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TC42754
—
RI
Enumeration date
04/06/2006
Last updated
06/14/2024
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