Basic Information
| Provider Information | |||||||||
| NPI: | 1659434892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMMEL | ||||||||
| FirstName: | TED | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 S BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | MT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170640550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009320359 | ||||||||
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| Practice Location | |||||||||
| Address1: | 283 S BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | MT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170640550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009320359 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS007256L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.