Organization
INTEGRAL HEALTH PSYCHOLOGY SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL JOHN BRODERICK PHD (PRESIDENT)
(765) 808-1687
Entity
Organization
Contact information
Practice address
605 S MIRAMAR WAY, MUNCIE, IN 47304-6723
(765) 281-1442
Mailing address
605 S MIRAMAR WAY, MUNCIE, IN 47304-6723
(765) 281-1442
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028559
M-PLAN
IN
01
—
000000371406
ANTHEM BLUE CROSS
IN
05
—
200532030A
—
IN
01
—
837986000
MAGELLAN HEALTH SERVICES
IN
Enumeration date
03/06/2007
Last updated
07/01/2013
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