Provider Demographics
NPI:1265061998
Name:GATEWAY PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:GATEWAY PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-777-1852
Mailing Address - Street 1:8116 SINGLETON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2563
Mailing Address - Country:US
Mailing Address - Phone:317-777-1852
Mailing Address - Fax:
Practice Address - Street 1:435 E MAIN ST STE 195
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1456
Practice Address - Country:US
Practice Address - Phone:317-777-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health