Healthcare Provider Details

I. General information

NPI: 1467623892
Provider Name (Legal Business Name): PATRICIA RUMBLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S SPRINGHILL JCT
TERRE HAUTE IN
47802-4584
US

IV. Provider business mailing address

4600 S SPRINGHILL JCT
TERRE HAUTE IN
47802-4584
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-2244
  • Fax: 812-242-2210
Mailing address:
  • Phone: 812-242-2244
  • Fax: 812-242-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34000659A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: