Provider Demographics
NPI:1730176587
Name:SPORES, JOHN MICHAEL (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SPORES
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2110 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-2819
Mailing Address - Country:US
Mailing Address - Phone:219-762-9556
Mailing Address - Fax:219-762-7318
Practice Address - Street 1:3349 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46368-5015
Practice Address - Country:US
Practice Address - Phone:219-762-9556
Practice Address - Fax:219-762-7318
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040638A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical