Provider Demographics
NPI:1043272495
Name:IRELAND, JOHN F (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:IRELAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3101 N GREEN RIVER RD
Mailing Address - Street 2:SUITE 910
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1369
Mailing Address - Country:US
Mailing Address - Phone:812-479-1916
Mailing Address - Fax:812-479-5014
Practice Address - Street 1:3101 N GREEN RIVER RD
Practice Address - Street 2:SUITE 910
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1369
Practice Address - Country:US
Practice Address - Phone:812-479-1916
Practice Address - Fax:812-479-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010339A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000188106OtherANTHEM BC/BS PROVIDER #