Craig Allan Nordstrom, PSYD, HSPP
Individual provider Active NPI Clinical Psychologist · Beverly Shores, IN
NPI 1154942340 · NPPES record last updated Apr 29, 2020
Key facts
- NPI
- 1154942340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 20041303A (IN)
- Practice address
- 111 E Clearwater Ave
Beverly Shores, IN 46301-0056 - Phone
- (219) 628-3650
- Fax
- (844) 364-4603
- NPI assigned
- Apr 29, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041303A | IN | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20041303A | IN | Yes |
Addresses
Primary practice location
111 E Clearwater Ave
Beverly Shores, IN 46301-0056
Mailing address
PO Box 2344
Portage, IN 46368-5844
Phone (219) 628-3650
Other practice location 1
600 S Main St Ste 309
Elkhart, IN 46516-3248
Phone (219) 628-3650
Other providers in Beverly Shores, IN
All providers in Beverly Shores, IN · Clinical Psychologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.