Individual
MRS. GWENDOLYN C DEHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
34003375
IN
1041C0700X
Clinical Social Worker
Primary
34003375
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000018781300
BLUE CROSS BLUE SHIELD
IN
01
—
34003375
STATE LICENCE NUMBER
IN
Enumeration date
07/07/2005
Last updated
08/27/2013
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