Provider Demographics
NPI:1669638458
Name:KIVISTO, AARON JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:JOHN
Last Name:KIVISTO
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 1:160 W CARMEL DR STE 247
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7586
Mailing Address - Country:US
Mailing Address - Phone:317-960-4899
Mailing Address - Fax:317-960-4899
Practice Address - Street 1:160 W CARMEL DR STE 247
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7586
Practice Address - Country:US
Practice Address - Phone:317-960-4899
Practice Address - Fax:317-960-4899
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042629A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical