Lifespan Neuropsycology, PC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20040858A Issued in IN

Legal business name

LIFESPAN NEUROPSYCOLOGY, PC

Practice address

1060 East 86TH St.
Suite 63D
Indianapolis, IN 46240-1831

Phone

(317) 569-9922

Fax

(317) 962-1895

NPI assigned

Dec 2, 2008

Last updated

Dec 2, 2008By 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

Bryan A Hudson, PHD

Title

Owner/Phsyician

Phone

(317) 962-2594

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1801031042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 WEST 86TH ST.",
            "address_2": "SUITE 245",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602103",
            "telephone_number": "317-569-9922",
            "fax_number": "317-962-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 EAST 86TH ST.",
            "address_2": "SUITE 63D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401831",
            "telephone_number": "317-569-9922",
            "fax_number": "317-962-1895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN NEUROPSYCOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHSYICIAN",
        "authorized_official_telephone_number": "317-962-2594",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040858A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.