Provider Demographics
NPI:1942272992
Name:HATFIELD, BOBBY BOYD JR (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:BOYD
Last Name:HATFIELD
Suffix:JR
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 1:8711 S COUNTY ROAD 600 E STE A
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:IN
Mailing Address - Zip Code:47383-9338
Mailing Address - Country:US
Mailing Address - Phone:765-730-2649
Mailing Address - Fax:
Practice Address - Street 1:8711 S COUNTY ROAD 600 E
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:IN
Practice Address - Zip Code:47383-9338
Practice Address - Country:US
Practice Address - Phone:765-730-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041571A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2628219000OtherMAGELLAN
IN000000183925OtherANTHEM BLUE CROSS BLUE SH
IN200271790Medicaid
IN200271790Medicaid