Provider Demographics
NPI:1285714485
Name:FALKENHAIN, MARC (PHD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:FALKENHAIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-481-8493
Mailing Address - Fax:812-481-8497
Practice Address - Street 1:721 W 13TH ST STE 101
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1856
Practice Address - Country:US
Practice Address - Phone:812-481-5780
Practice Address - Fax:812-481-5784
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041888A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN216660AMedicare ID - Type UnspecifiedMEDICARE