Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 20040712 | IN |
NPI | 1053488197 |
---|---|
Provider Name | Dr. Galen Arthur Yordy |
First Address | Fort Wayne, IN 46807-2864 |
Second Address | Fort Wayne, IN 46807-1218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 20/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100332280 | (05) | IN |
B28086 | (02) | IN |
S20681 | (02) | IN |