Indiana Professional Psychological Services, P.C.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

20040759A Issued in IN

Legal business name

INDIANA PROFESSIONAL PSYCHOLOGICAL SERVICES, P.C.

Practice address

6408 Constitution Dr
Fort Wayne, IN 46804-1558

Phone

(260) 469-0090

Fax

(260) 469-0091

NPI assigned

Feb 27, 2008

Last updated

Nov 3, 2011By 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

Dr. Daniel Lee Baney, PH.D.

Title

Psychologist, President Ipps

Phone

(260) 469-0090

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1992974620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6408 CONSTITUTION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041558",
            "telephone_number": "260-469-0090",
            "fax_number": "260-469-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6408 CONSTITUTION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041558",
            "telephone_number": "260-469-0090",
            "fax_number": "260-469-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PROFESSIONAL PSYCHOLOGICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "BANEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PSYCHOLOGIST, PRESIDENT IPPS",
        "authorized_official_telephone_number": "260-469-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "20040759A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "200450",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Fort Wayne, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.