Healthcare Provider Details

I. General information

NPI: 1497187256
Provider Name (Legal Business Name): STEVEN ANDREW HAWLEY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MICHIGAN AVE
LOGANSPORT IN
46947-1526
US

IV. Provider business mailing address

1015 MICHIGAN AVE
LOGANSPORT IN
46947-1526
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-5151
  • Fax: 574-739-1414
Mailing address:
  • Phone: 574-722-5151
  • Fax: 574-739-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: