Healthcare Provider Details

I. General information

NPI: 1023944337
Provider Name (Legal Business Name): BLOOMINGTON BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 E 3RD ST
BLOOMINGTON IN
47401-5504
US

IV. Provider business mailing address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-4969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CRAIG SMEDLEY
Title or Position: CO-OWNER
Credential:
Phone: 812-320-4969