Provider Demographics
NPI:1588950554
Name:HEAD, DEVONA M (LMHC)
Entity type:Individual
Prefix:
First Name:DEVONA
Middle Name:M
Last Name:HEAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7474 HARBOUR ISLE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3473
Mailing Address - Country:US
Mailing Address - Phone:317-931-9243
Mailing Address - Fax:
Practice Address - Street 1:16162 CAREY RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8925
Practice Address - Country:US
Practice Address - Phone:317-931-9243
Practice Address - Fax:317-867-3990
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000227A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional