Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20010438A | IN |
Y | 103TC0700X | Clinical Psychologist | 20010438A | IN |
NPI | 1003833096 |
---|---|
Provider Name | Raymond W Horn |
First Address | Indianapolis, IN 46290-1079 |
Second Address | Indianapolis, IN 46290-1079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R33502 | (02) |