Provider Demographics
NPI:1518091768
Name:RUMBLE, STEVEN ROGER (PHD HSPP)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROGER
Last Name:RUMBLE
Suffix:
Gender:M
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1112
Mailing Address - Country:US
Mailing Address - Phone:317-887-6742
Mailing Address - Fax:
Practice Address - Street 1:650 E SOUTHPORT RD
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8592
Practice Address - Country:US
Practice Address - Phone:317-782-6015
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251760AMedicaid
IN20040148OtherHSPP (LICENTURE NO.)
IN100251760AMedicaid