Provider Demographics
NPI:1255046694
Name:SUNRISE PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:SUNRISE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-475-2957
Mailing Address - Street 1:15834 ARBOR CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7858
Mailing Address - Country:US
Mailing Address - Phone:574-216-1686
Mailing Address - Fax:812-585-3802
Practice Address - Street 1:6910 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9680
Practice Address - Country:US
Practice Address - Phone:574-475-2957
Practice Address - Fax:812-585-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty