Provider Demographics
NPI:1124302237
Name:ABERDEEN GROUP LLC
Entity type:Organization
Organization Name:ABERDEEN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSY.D. HSPP/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DETTMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD HSPP
Authorized Official - Phone:260-373-0880
Mailing Address - Street 1:12948 COLDWATER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8016
Mailing Address - Country:US
Mailing Address - Phone:260-373-0880
Mailing Address - Fax:260-373-0881
Practice Address - Street 1:12948 COLDWATER RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8016
Practice Address - Country:US
Practice Address - Phone:260-373-0880
Practice Address - Fax:260-373-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100062453Medicare PIN