Healthcare Provider Details

I. General information

NPI: 1184446817
Provider Name (Legal Business Name): XIANG ZHOU HSPP, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6794 KEEPSAKE DR
WHITESTOWN IN
46075-6204
US

IV. Provider business mailing address

6794 KEEPSAKE DR
WHITESTOWN IN
46075-6204
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20043414B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: