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Individual

MR. JARED EATON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD, HSPP

Contact information

Practice address
1441 E 84TH PL, MERRILLVILLE, IN 46410-6451
(219) 736-9115
(219) 794-2010
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1928
(219) 757-1950

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042868A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201313820
IN
Enumeration date
08/03/2010
Last updated
09/17/2015
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