Provider Demographics
NPI:1861209017
Name:LISTEN WELL TELEPSYCHIATRY, LLC
Entity type:Organization
Organization Name:LISTEN WELL TELEPSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-994-0918
Mailing Address - Street 1:3105 S SARE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-0052
Mailing Address - Country:US
Mailing Address - Phone:812-994-0918
Mailing Address - Fax:
Practice Address - Street 1:3105 S SARE RD STE 400
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-0052
Practice Address - Country:US
Practice Address - Phone:812-994-0918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty