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General NPI Number Information
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NPI Number | 1770749368
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Entity Type | Individual
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Provider Name | JOHN GUARE PHD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2008
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Last Update Date | 08/03/2008
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Provider Practice Location Address
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Address Line | 6625 NETWORK WAY STE 100 INTECH ELEVEN
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-0007
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Country | US
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Telephone | 317-275-7010
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Fax | 317-275-7012
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Provider Business Mailing Address
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Address Line | 9444 CARLYLE DR APT A
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3909
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Country | US
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Telephone | 317-525-8213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 20041443A
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License Number State | IN
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