Healthcare Provider Details

I. General information

NPI: 1528959491
Provider Name (Legal Business Name): QUALITY OF LIFE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROADWAY
CHESTERTON IN
46304-2259
US

IV. Provider business mailing address

621 BROADWAY
CHESTERTON IN
46304-2259
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-5492
  • Fax: 219-921-0143
Mailing address:
  • Phone: 219-921-5492
  • Fax: 219-921-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANTHONY MICHAEL MCCROVITZ
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 219-921-5492