Active NPI
Shruti Singh Poulsen, PH.D.
- Marriage & Family Therapist
- Lafayette, IN
National Provider Identifier
1265463210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35001468A
- Practice address
- 2201 Ferry St
Heartland Clinic
Lafayette, IN 47904-3047 - Phone
- (765) 446-9898
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 35001468A | IN | Primary |
Addresses
Primary practice location
2201 Ferry St
Heartland Clinic
Lafayette, IN 47904-3047
Mailing address
1508 Summit Dr.
West Lafayette, IN 47906-2228
Phone (765) 463-2995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35001468A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265463210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 SUMMIT DR.",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479062228",
"telephone_number": "765-463-2995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 FERRY ST",
"address_2": "HEARTLAND CLINIC",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479043047",
"telephone_number": "765-446-9898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULSEN",
"first_name": "SHRUTI",
"middle_name": "SINGH",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35001468A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.