Healthcare Provider Details

I. General information

NPI: 1225423650
Provider Name (Legal Business Name): DEVONA GRUBER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W KILGORE AVE
MUNCIE IN
47304-4810
US

IV. Provider business mailing address

3700 W KILGORE AVE
MUNCIE IN
47304-4810
US

V. Phone/Fax

Practice location:
  • Phone: 765-289-5437
  • Fax: 317-375-7747
Mailing address:
  • Phone: 765-289-5437
  • Fax: 317-375-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: