=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649004185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIAN FRENCH PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2024
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1391 N BALDWIN AVE STE 200
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46952-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-660-7900
-----------------------------------------------------
Fax | 765-671-7751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4124 S LANDESS ST # 1
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46953-4939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-544-3833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 20043858A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------