Provider Demographics
NPI:1366815615
Name:PSI SERVICES OF INDIANA INC.
Entity type:Organization
Organization Name:PSI SERVICES OF INDIANA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:OTIS
Authorized Official - Last Name:SWOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:219-756-8201
Mailing Address - Street 1:8120 GEORGIA ST STE D
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6391
Mailing Address - Country:US
Mailing Address - Phone:219-756-8201
Mailing Address - Fax:219-756-8203
Practice Address - Street 1:8120 GEORGIA ST STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6391
Practice Address - Country:US
Practice Address - Phone:219-756-8201
Practice Address - Fax:219-756-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)