Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1616493 | IN |
Y | 103T00000X | Psychologist | 1616493 | IN |
NPI | 1013482397 |
---|---|
Provider Name | Mrs. Lisa E. Dial |
First Address | Indianapolis, IN 46236-8873 |
Second Address | Brownsburg, IN 46112-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2018 |
Last Update Date | 12/10/2018 |