Healthcare Provider Details

I. General information

NPI: 1407474257
Provider Name (Legal Business Name): WILLIAM LAWRENCE HEARD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10428 PRIVET DR
CROWN POINT IN
46307-5383
US

IV. Provider business mailing address

10428 PRIVET DR
CROWN POINT IN
46307-5383
US

V. Phone/Fax

Practice location:
  • Phone: 219-202-8747
  • Fax: 219-301-8748
Mailing address:
  • Phone: 219-202-8747
  • Fax: 219-301-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043390A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: