Provider Type Icon

GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH NPI 1750599981


NPI Information

NPI: 1750599981
Provider Name: GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Organization
Address:
494 S EMERSON AVE
SUITE C
GREENWOOD, IN
ZIP 46143
Phone: (317) 889-3901
Get Directions

GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH is a clinical neuropsychologist in Greenwood, IN. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH NPI is 1750599981. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

494 S EMERSON AVE
SUITE C
GREENWOOD, IN
ZIP 46143-912
Phone: (317) 889-3901
Fax: (317) 889-3902

The provider's authorized official is Sanford Lloyd Pederson .
The authorized official title is President and has the following contact phone number (317) 889-3901.

The enumeration date for this NPI number is 5/20/2007 and was last updated on 3/19/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TA0700XPsychologistAdult Development & AgingNo
2103TC0700XPsychologistClinicalNo
3103TC2200XPsychologistClinical Child & AdolescentNo
4103TF0200XPsychologistForensicNo
5103TH0004XPsychologistHealthNo
6103TH0100XPsychologistHealth ServiceNo
7103TR0400XPsychologistRehabilitationNo
8103G00000XClinical NeuropsychologistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200227370MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.