Healthcare Provider Details

I. General information

NPI: 1275683013
Provider Name (Legal Business Name): SHARYL A ALTUM HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W EADS PKWY
LAWRENCEBURG IN
47025-1139
US

IV. Provider business mailing address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-7375
  • Fax:
Mailing address:
  • Phone: 812-537-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041835A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: