NPIMap

Organization Active NPI

Heath H Fervida PC

  • Clinical Psychologist
  • Goshen, IN
National Provider Identifier
1285928176
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042483A Issued in IN
Legal business name
HEATH H FERVIDA PC
Practice address
1930 W Lincoln Ave
Goshen, IN 46526-5907
Phone
(574) 534-2161
Fax
(574) 534-3887
NPI assigned
Jun 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Heath Herbert Fervida, PSYD, HSPP
Title
Owner
Phone
(574) 534-2161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 20042483A IN Primary

Addresses

Primary practice location

1930 W Lincoln Ave
Goshen, IN 46526-5907

Mailing address

1930 W Lincoln Ave
Goshen, IN 46526-5907
Phone (574) 534-2161

National Provider Directory

National Provider Directory

Locations

1930 W Lincoln Ave
Goshen, IN 46526
Phone (574) 534-2161

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1285928176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 W LINCOLN AVE",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265907",
            "telephone_number": "574-534-2161",
            "fax_number": "574-534-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 W LINCOLN AVE",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265907",
            "telephone_number": "574-534-2161",
            "fax_number": "574-534-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATH H FERVIDA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-08",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "FERVIDA",
        "authorized_official_first_name": "HEATH",
        "authorized_official_middle_name": "HERBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-534-2161",
        "authorized_official_credential": "PSYD, HSPP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042483A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.