Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1114590148 |
---|---|
Provider Name | Conrad Ellsworth Hartman |
First Address | Angola, IN 46703-1704 |
Second Address | New Albany, IN 47150-6954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |