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Individual

MARY LOCKE SHEAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
7337 W JEFFERSON BLVD, SUITE 175, FORT WAYNE, IN 46804-6284
(260) 436-7131
(260) 436-5123
Mailing address
7337 W JEFFERSON BLVD, SUITE 175, FORT WAYNE, IN 46804-6284
(260) 436-7131
(260) 436-5123

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040180
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100090960
IN
Enumeration date
08/29/2005
Last updated
10/29/2012
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