Provider Demographics
NPI:1447277421
Name:VALLE VISTA GUIDANCE CENTER PC
Entity type:Organization
Organization Name:VALLE VISTA GUIDANCE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKU
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-887-2121
Mailing Address - Street 1:896 E MAIN ST
Mailing Address - Street 2:4
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1440
Mailing Address - Country:US
Mailing Address - Phone:317-887-2121
Mailing Address - Fax:317-887-5731
Practice Address - Street 1:896 E MAIN ST
Practice Address - Street 2:4
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1440
Practice Address - Country:US
Practice Address - Phone:317-887-2121
Practice Address - Fax:317-887-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN595390Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER