Healthcare Provider Details

I. General information

NPI: 1285714485
Provider Name (Legal Business Name): MARC FALKENHAIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W 13TH ST STE 101
JASPER IN
47546-1856
US

IV. Provider business mailing address

PO BOX 1028
JASPER IN
47547-1028
US

V. Phone/Fax

Practice location:
  • Phone: 812-481-5780
  • Fax: 812-481-5784
Mailing address:
  • Phone: 812-481-8493
  • Fax: 812-481-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041888A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: