Healthcare Provider Details

I. General information

NPI: 1003986795
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL DEVELOPMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 N MARTIN AVE
MUNCIE IN
47303-3537
US

IV. Provider business mailing address

526 N MARTIN AVE
MUNCIE IN
47303-3537
US

V. Phone/Fax

Practice location:
  • Phone: 765-287-1922
  • Fax:
Mailing address:
  • Phone: 765-287-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: TAMMY L LAMPKE
Title or Position: BILLING
Credential:
Phone: 765-287-1922