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General NPI Number Information
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NPI Number | 1972106599
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Entity Type | Organization
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Legal Business Name | WELLHOME PSYCHOLOGY, PC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 12/29/2024
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Provider Practice Location Address
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Address Line | 15262 W 400 N
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City | MEDARYVILLE
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State | IN
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Zip | 47957-8107
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Country | US
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Telephone | 219-804-6262
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Fax | 877-497-6001
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Provider Business Mailing Address
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Address Line | 417 W 81ST AVE # 132
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5317
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Country | US
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Telephone | 219-804-6262
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Fax | 877-497-6001
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JENNIFER DYARMAN
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Credential | PSYD LCSW LCAC
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Telephone | 260-413-6994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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