Provider Demographics
NPI:1669687877
Name:LINK, NANCY H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:H
Last Name:LINK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 FARMWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-1905
Mailing Address - Country:US
Mailing Address - Phone:219-324-7063
Mailing Address - Fax:219-362-1962
Practice Address - Street 1:900 I STREET
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5533
Practice Address - Country:US
Practice Address - Phone:219-324-7063
Practice Address - Fax:219-362-1962
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041588A103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200297340 AMedicaid
IN200297340AMedicaid
IN193200Medicare UPIN
IN200297340AMedicaid