Provider Demographics
NPI:1073910360
Name:THE PSYCHOTHERAPY OFFICES OF DAVID KEARBY LCSW, LLC
Entity Type:Organization
Organization Name:THE PSYCHOTHERAPY OFFICES OF DAVID KEARBY LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KEARBY
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-215-0548
Mailing Address - Street 1:6413 KENTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4864
Mailing Address - Country:US
Mailing Address - Phone:317-215-0548
Mailing Address - Fax:
Practice Address - Street 1:429 E VERMONT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3690
Practice Address - Country:US
Practice Address - Phone:317-215-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006810A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty