Individual
DR. THOMAS PAUL DETTMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
6223 CONSTITUTION DR, FORT WAYNE, IN 46804-1517
(260) 755-5896
Mailing address
1614 ALABAMA AVE, FORT WAYNE, IN 46805-5012
(260) 609-7007
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
39002939A
IN
Other
Enumeration date
06/23/2009
Last updated
08/26/2010
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