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General NPI Number Information
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NPI Number | 1073910360
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Entity Type | Organization
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Legal Business Name | THE PSYCHOTHERAPY OFFICES OF DAVID KEARBY LCSW, LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 429 E VERMONT ST SUITE 205
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3690
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Country | US
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Telephone | 317-215-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 6413 KENTSTONE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-4864
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Country | US
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Telephone | 317-215-0548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID ALAN KEARBY II
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Credential | LCSW
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Telephone | 317-215-0548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34006810A
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License Number State | IN
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