Healthcare Provider Details

I. General information

NPI: 1558304741
Provider Name (Legal Business Name): STEVEN WHAM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 PHYSICIANS CT SUITE 2
EVANSVILLE IN
47715-4031
US

IV. Provider business mailing address

6221 EAST PHYSICIANS CT SUITE 2
EVANSVILLE IN
47715
US

V. Phone/Fax

Practice location:
  • Phone: 812-491-7739
  • Fax: 812-491-8095
Mailing address:
  • Phone: 812-491-7739
  • Fax: 812-491-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0897
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: