NPI 1104833284 · live from the CMS NPI Registry
Larry Dale Archer, Clinical Psychologis
Psychologist, Clinical in Evansville, IN. National Provider Identifier 1104833284, active.
NPI record
| NPI | 1104833284 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | Evansville Va Health Care Center, 6211 E. Waterford Blvd., Evansville, IN 47715 |
| Practice phone | 812-465-6202 |
| Mailing address | 722 Mels Dr, Evansville, IN 47712 |
| Enumerated | August 2, 2006 |
| Last updated | May 17, 2018 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical primary | 103TC0700X | 20040417A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.