Provider Demographics
NPI:1215801253
Name:LASUERTMER, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LASUERTMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 E STREACHER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9790
Mailing Address - Country:US
Mailing Address - Phone:765-490-1250
Mailing Address - Fax:
Practice Address - Street 1:101 W KIRKWOOD AVE STE 140
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6132
Practice Address - Country:US
Practice Address - Phone:765-490-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34012148A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty