Provider Demographics
NPI:1730413014
Name:SUNDBERG, CARL THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:THOMAS
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11435 SPYGLASS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9475
Mailing Address - Country:US
Mailing Address - Phone:317-223-5041
Mailing Address - Fax:
Practice Address - Street 1:11435 SPYGLASS RIDGE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9475
Practice Address - Country:US
Practice Address - Phone:317-223-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-08-4212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst