Provider Demographics
NPI:1942368626
Name:KISER, DAVID JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:KISER
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 1:802 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1439
Mailing Address - Country:US
Mailing Address - Phone:765-428-8800
Mailing Address - Fax:765-446-0697
Practice Address - Street 1:802 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1439
Practice Address - Country:US
Practice Address - Phone:765-428-8800
Practice Address - Fax:765-428-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000428A1041C0700X
IN35000871A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000202222OtherBCBS
IN000000202222OtherBCBS