Healthcare Provider Details

I. General information

NPI: 1275556680
Provider Name (Legal Business Name): DAN HALL WYCH PH.D. HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 HOLLIDAY DR
INDIANAPOLIS IN
46260-1706
US

IV. Provider business mailing address

8806 HOLLIDAY DR
INDIANAPOLIS IN
46260-1706
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-4895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010333A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: