Individual provider Active NPI

Julie Harrison, PHD

  • Clinical Psychologist
  • Indianapolis, IN
National Provider Identifier
1407890700
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20041897A Issued in IN
Practice address
920 N Shadeland Ave
Suite G-6a
Indianapolis, IN 46219-4898
Phone
(317) 600-1620
NPI assigned
Jun 16, 2006
Last updated
May 16, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 20041897A IN Primary
Psychologist 103T00000X 20041897A IN

Addresses

Primary practice location

920 N Shadeland Ave
Suite G-6a
Indianapolis, IN 46219-4898

Mailing address

1229 N Hawthorne LN
Indianapolis, IN 46219-2941

Other identifiers 3

IdentifierTypeStateIssuer
200260480AMedicaidIN
000000322924OtherINANTHEM
P00217244OtherINRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040622000003 IN Practitioner - Clinical Psychologist 6709861024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

920 N Shadeland Ave
Suite G6A
Indianapolis, IN 46219-4888
Phone (317) 600-1620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20041897AINMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Harrison Psychological Consultations, LLC Clinical CurrentSince May 15, 2012 Accepting new patients
Psychological Laboratories of Indianapolis, PC Psychologist Past Accepting new patients

Locations

920 N Shadeland Ave
Ste G6A
Indianapolis, IN 46219
Phone (317) 600-1620

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1407890700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 N HAWTHORNE LN",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462192941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N SHADELAND AVE",
            "address_2": "SUITE G-6A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194898",
            "telephone_number": "317-600-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "JULIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041897A",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041897A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200260480A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000322924",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00217244",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.