Provider Demographics
NPI:1144438326
Name:ATHIALY, ABRAHAM
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:ATHIALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 N COUNTY ROAD 625 E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9724
Mailing Address - Country:US
Mailing Address - Phone:317-272-6999
Mailing Address - Fax:
Practice Address - Street 1:79 N COUNTY ROAD 625 E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9724
Practice Address - Country:US
Practice Address - Phone:317-272-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000774A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health