Organization
PSYCHOLOGICAL ASSESSMENT AND CONSULTING, PC
Active
Other names
Willow Branch Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE KIMMERLING PHD (PRESIDENT)
(765) 755-0052
Entity
Organization
Contact information
Practice address
1806 W ROYALE DR, MUNCIE, IN 47304-2243
(765) 755-0052
(765) 755-0052
Mailing address
1806 W ROYALE DR, MUNCIE, IN 47304-2243
(765) 755-0052
(765) 755-0052
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041639A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000588248
ANTHEM BC/BS PIN
IN
01
—
11646258
CAQH
IN
05
—
200911770A
—
IN
Enumeration date
08/25/2008
Last updated
03/06/2023
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