Provider Demographics
NPI:1710918651
Name:VERCRUYSSE, SHEILA SEUFERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:SEUFERT
Last Name:VERCRUYSSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LIBRARY BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1567
Mailing Address - Country:US
Mailing Address - Phone:317-887-6308
Mailing Address - Fax:317-889-5912
Practice Address - Street 1:1701 LIBRARY BLVD STE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1567
Practice Address - Country:US
Practice Address - Phone:317-887-6308
Practice Address - Fax:317-889-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN595360Medicare ID - Type Unspecified