=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659496800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA LYNN HAVILL MSW, ACSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 12/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9135 N MERIDIAN ST STE A9
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-502-5781
-----------------------------------------------------
Fax | 317-581-1781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9135 N MERIDIAN ST STE A9
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-502-5781
-----------------------------------------------------
Fax | 317-581-1781
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34001968A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------