Provider Demographics
NPI:1578836276
Name:HIGGINBOTHAM, DARREN LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:LEE
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 E 65TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-3178
Mailing Address - Country:US
Mailing Address - Phone:317-643-9901
Mailing Address - Fax:
Practice Address - Street 1:11925 E 65TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-3178
Practice Address - Country:US
Practice Address - Phone:317-643-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042135A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical