Healthcare Provider Details

I. General information

NPI: 1528310190
Provider Name (Legal Business Name): TIMOTHY M MCCURDY PSYD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 HIGHWAY AVE
HIGHLAND IN
46322-1613
US

IV. Provider business mailing address

8400 LOUISIANA ST
MERRILLVILLE IN
46410-6385
US

V. Phone/Fax

Practice location:
  • Phone: 219-972-0131
  • Fax: 219-972-9104
Mailing address:
  • Phone: 219-757-1928
  • Fax: 219-757-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: