Provider Demographics
NPI:1548530215
Name:PARIS PSYCHOLOGICAL SERVICES,PC
Entity type:Organization
Organization Name:PARIS PSYCHOLOGICAL SERVICES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:260-705-2152
Mailing Address - Street 1:11307 NOTESTINE RD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9735
Mailing Address - Country:US
Mailing Address - Phone:260-705-2152
Mailing Address - Fax:260-485-4357
Practice Address - Street 1:11307 NOTESTINE RD
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-9735
Practice Address - Country:US
Practice Address - Phone:260-705-2152
Practice Address - Fax:260-485-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040061A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S01602Medicare UPIN