Basic Information
| Provider Information | |||||||||
| NPI: | 1407900483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULIAN CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 N MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462021305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179412200 | ||||||||
| FaxNumber: | 3179412208 | ||||||||
| Practice Location | |||||||||
| Address1: | 2011 N MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462021305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179412200 | ||||||||
| FaxNumber: | 3179412208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 03/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | WALDRIP | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3179412200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 200107310A | 05 | IN | MEDICAID | 316383 | 01 | IN | VALUE OPTIONS | OTHER | 726197000 | 01 | IN | MAGELLAN | OTHER | 4644404 | 01 | IN | AETNA | OTHER |