Provider Demographics
NPI:1780480822
Name:AQUARIAN MINISTRY LTD SPIRITUALIST CHURCH OF INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:AQUARIAN MINISTRY LTD SPIRITUALIST CHURCH OF INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-907-4198
Mailing Address - Street 1:858 N LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-2556
Mailing Address - Country:US
Mailing Address - Phone:317-907-4198
Mailing Address - Fax:
Practice Address - Street 1:GRACE CLINIC
Practice Address - Street 2:620 8TH AVE
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804
Practice Address - Country:US
Practice Address - Phone:812-231-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty