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General NPI Number Information
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NPI Number | 1700163102
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Entity Type | Organization
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Legal Business Name | MARTIN GROFF PH.D. LLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 9240 N MERIDIAN ST SUITE 320
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1880
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Country | US
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Telephone | 317-844-7489
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Fax | 317-581-1007
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Provider Business Mailing Address
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Address Line | PO BOX 983
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City | NOBLESVILLE
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State | IN
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Zip | 46061-0983
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Country | US
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Telephone | 317-844-7489
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN GARY GROFF
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Credential | PH.D.
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Telephone | 317-844-7489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20010411A
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License Number State | IN
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