Bloomington Neurofeedback

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BLOOMINGTON NEUROFEEDBACK

Practice address

1905 S Liberty Dr
Bloomington, IN 47403-5146

Phone

(812) 668-6220

Fax

(812) 668-6225

NPI assigned

Oct 11, 2020

Last updated

Oct 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rhonda Souder, LMHCNPI 1073585311

Title

Owner

Phone

(502) 232-0405

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rhonda J Souder, ED.S., LMHC

  • Mental Health Counselor
  • Columbus, IN
  • NPI 1073585311
  NPD Authorized official

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

{
    "created_epoch": "1602374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602374400000",
    "number": "1710585997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 S LIBERTY DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035146",
            "telephone_number": "812-688-6220",
            "fax_number": "812-668-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 S LIBERTY DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035146",
            "telephone_number": "812-668-6220",
            "fax_number": "812-668-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON NEUROFEEDBACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-11",
        "last_updated": "2020-10-11",
        "certification_date": "2020-10-11",
        "status": "A",
        "authorized_official_last_name": "SOUDER",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-232-0405",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.