Doctor Name: | MRS. ELIZABETH FOMLEY |
NPI Number: | 1497025670 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 3948 D New Vision Drive Ft Wayne, IN - 468451721 |
Business Phone Number: | 2603876340 |
Business Fax Number: | |
Mailing Address: | 3948 D New Vision Drive, Vision Counseling And Psychological Service FT WAYNE |
State: | IN |
Postal Code: | 468451721 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/05/2012 |
NPI Last Update Date: | 01/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |