Provider Demographics
NPI:1437831286
Name:PROCTOR, JOHN HENRY III (LSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HENRY
Last Name:PROCTOR
Suffix:III
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1420
Mailing Address - Country:US
Mailing Address - Phone:317-650-4353
Mailing Address - Fax:
Practice Address - Street 1:777 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1420
Practice Address - Country:US
Practice Address - Phone:317-650-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011601A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker