Healthcare Provider Details

I. General information

NPI: 1699893883
Provider Name (Legal Business Name): BETH A. TRAMMELL PH.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 W ROYALE DR
MUNCIE IN
47304-2264
US

IV. Provider business mailing address

1904 W ROYALE DR
MUNCIE IN
47304-2264
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-0443
  • Fax: 765-284-4112
Mailing address:
  • Phone: 765-284-0043
  • Fax: 765-284-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042638A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20042638A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042638A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: