Healthcare Provider Details

I. General information

NPI: 1851056337
Provider Name (Legal Business Name): MRS. ASRA SYED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 01/06/2022
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD N
NOBLESVILLE IN
46060-4366
US

IV. Provider business mailing address

14540 PRAIRIE LAKES BLVD N
NOBLESVILLE IN
46060-4366
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-5433
  • Fax:
Mailing address:
  • Phone: 310-483-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35002184A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: