Provider Demographics
NPI:1174794812
Name:ANGELA M. TOMLIN, PH.D.
Entity type:Organization
Organization Name:ANGELA M. TOMLIN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-439-8567
Mailing Address - Street 1:470 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3115
Mailing Address - Country:US
Mailing Address - Phone:317-439-8567
Mailing Address - Fax:317-885-9566
Practice Address - Street 1:470 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3115
Practice Address - Country:US
Practice Address - Phone:317-439-8567
Practice Address - Fax:317-885-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040448A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty