Organization
DAVIS MINTUN PROFESSIONAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS GARTH MINTUN LCSW (VICE PRESIDENT)
(317) 578-2122
Entity
Organization
Contact information
Practice address
6801 LAKE PLAZA DR, STE A102, INDIANAPOLIS, IN 46220-4061
(317) 578-2122
(317) 578-3655
Mailing address
6801 LAKE PLAZA DR, STE A102, INDIANAPOLIS, IN 46220-4061
(317) 578-2122
(317) 578-3655
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001376A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497794572
INDIVIDUAL NPI NUMBER FOR THOMAS GARTH MINTUN
IN
Enumeration date
12/06/2016
Last updated
12/06/2016
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