Theresa Costello, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20042231A Issued in IN

Practice address

2158 Intelliplex Dr Ste 200
Shelbyville, IN 46176-8549

Phone

(317) 398-2812

NPI assigned

Apr 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Isaacs & Associates

  • Clinical Social Worker
  • Walpole, MA
  • NPI 1356402879
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1730141433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 INTELLIPLEX DR STE 200",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461768549",
            "telephone_number": "317-398-2812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 INTELLIPLEX DR STE 200",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461768549",
            "telephone_number": "317-398-2812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "THERESA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042231A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TC42754",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Comprehensive Pain and Spine Specialists LLC
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• Teethena Comeko Cooper, MD
• Amy Nicole Coopman, PTA
• Betsy Crandall, DDS
• Molly Kathleen Cremons, PA-C
• Ovidiu Gratian Cristea, MD, FACS
• Olivia Mary Cummings Mutambuze, MD
• Robin Curry, RN

• All providers in Shelbyville, IN
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.