Archer, Larry Dale

Archer, Larry Dale is an sole proprietor health care provider with primary practice located at Evansville Va Health Care Center 6211 E. Waterford Blvd., Evansville IN 47715. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Archer, Larry Dale can be contacted via phone (812) 465-6202.

Contact Information

Primary practice address
Evansville Va Health Care Center 6211 E. Waterford Blvd. Evansville IN 47715
Phone: (812) 465-6202
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20040417A Indiana

Profile Details

NPI number 1104833284
LBN Legal business name Archer, Larry Dale
Credentials CLINICAL PSYCHOLOGIS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 2nd, 2006
Last updated May 17th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104833284 NPPES
Indiana MEDICAID 100254440B

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