1700111457 NPI number — THOMAS ADRIAN DEHORN LMHC

Table of content: BRITTANY KNIGHT (NPI 1437859576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700111457 NPI number — THOMAS ADRIAN DEHORN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEHORN
Provider First Name:
THOMAS
Provider Middle Name:
ADRIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700111457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 SAINT JOHN RD
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
MICHIGAN CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46360-7354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-873-9828
Provider Business Mailing Address Fax Number:
219-873-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 SAINT JOHN RD
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-7354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-873-9828
Provider Business Practice Location Address Fax Number:
219-873-2388
Provider Enumeration Date:
10/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39000127A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100163580A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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