Organization
INDIANA PROFESSIONAL PSYCHOLOGICAL SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL LEE BANEY PH.D. (PSYCHOLOGIST, PRESIDENT IPPS)
(260) 469-0090
Entity
Organization
Contact information
Practice address
6408 CONSTITUTION DR, FORT WAYNE, IN 46804-1558
(260) 469-0090
(260) 469-0091
Mailing address
6408 CONSTITUTION DR, FORT WAYNE, IN 46804-1558
(260) 469-0090
(260) 469-0091
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
20040759A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200450
MEDICARE
—
Enumeration date
02/27/2008
Last updated
11/03/2011
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