Personal Development Associates

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

20040083A Issued in IN

Legal business name

PERSONAL DEVELOPMENT ASSOCIATES

Practice address

3225 North Meridian Street
Suite 200
Indianapolis, IN 46208-4680

Phone

(317) 923-6093

Fax

(317) 927-9833

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. C. Herbert Henry, PH. D., HSPP

Title

Owner

Phone

(317) 923-6093

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1801972203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 NORTH MERIDIAN STREET",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084680",
            "telephone_number": "317-923-6093",
            "fax_number": "317-927-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 NORTH MERIDIAN STREET",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084680",
            "telephone_number": "317-923-6093",
            "fax_number": "317-927-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL DEVELOPMENT ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "HERBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-923-6093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH. D., HSPP"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "20040083A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100227230",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.