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General NPI Number Information
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NPI Number | 1174794812
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Entity Type | Organization
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Legal Business Name | ANGELA M. TOMLIN, PH.D.
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 470 W MAIN ST
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City | GREENWOOD
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State | IN
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Zip | 46142-3115
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Country | US
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Telephone | 317-439-8567
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Fax | 317-885-9566
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Provider Business Mailing Address
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Address Line | 470 W MAIN ST
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City | GREENWOOD
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State | IN
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Zip | 46142-3115
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Country | US
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Telephone | 317-439-8567
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Fax | 317-885-9566
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELA MARIE TOMLIN
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Credential | PHD
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Telephone | 317-439-8567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20040448A
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License Number State | IN
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