Healthcare Provider Details

I. General information

NPI: 1912449950
Provider Name (Legal Business Name): DEEP KAUR BATTU PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 N BRADFORD DR
DELPHI IN
46923-9553
US

IV. Provider business mailing address

1265 N BRADFORD DR
DELPHI IN
46923-9553
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-2247
  • Fax: 765-564-2249
Mailing address:
  • Phone: 765-564-2247
  • Fax: 765-564-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number99075950A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004342A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: