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NPI Code Detail

MEDICARE: JACQUELINE A NUVAL PHD

MEDICARE: JACQUELINE A NUVAL PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist39024TX
2101YM0800XMental Health Counselor39000625AIN
3103TC0700XClinical PsychologistP.08436OH
4103TC0700XClinical Psychologist20042692AIN

General Provider Information

NPI Number : 1356505366
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE A NUVAL PHD
Provider Business Mailing Address
First Line : PO BOX 10299
Second Line :
City : FORT WAYNE
State : IN
Zip : 46851-0299
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Provider Business Practice Location Address
First Line : 4400 EASTON CMNS STE 125
Second Line :
City : COLUMBUS
State : OH
Zip : 43219-6223
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2008
Last Update Date : 02/23/2023

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Directions to “ JACQUELINE A NUVAL PHD” Practice Location

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