Healthcare Provider Details

I. General information

NPI: 1083299598
Provider Name (Legal Business Name): HEARD PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
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 TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HEARD
Title or Position: OWNER
Credential: PSYD
Phone: 219-202-8747