Provider Demographics
NPI:1053488197
Name:YORDY, GALEN ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:ARTHUR
Last Name:YORDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N SEMINOLE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2864
Mailing Address - Country:US
Mailing Address - Phone:260-744-1682
Mailing Address - Fax:260-422-1555
Practice Address - Street 1:2805 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1218
Practice Address - Country:US
Practice Address - Phone:260-456-4880
Practice Address - Fax:260-456-3559
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040712103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332280Medicaid
INB28086Medicare UPIN
IN137100DMedicare PIN
INS20681Medicare UPIN
IN185860Medicare ID - Type Unspecified