Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 20090241A | IN |
N | 103TC0700X | Clinical Psychologist | 20090241A | IN |
N | 102L00000X | Psychologist | 20090241A | IN |
N | 103T00000X | Psychologist | 20090241A | IN |
N | 103TR0400X | Rehabilitation Psychologist | 20090241A | IN |
N | 103TS0200X | School Psychologist | 20090241A | IN |
NPI | 1245399690 |
---|---|
Provider Name | Dr. Robert Burns Coyle |
First Address | Munster, IN 46321-2040 |
Second Address | Munster, IN 46321-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |