Healthcare Provider Details

I. General information

NPI: 1043804750
Provider Name (Legal Business Name): GEMSWITHIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 N MADISON ST
CROWN POINT IN
46307-8210
US

IV. Provider business mailing address

756 N MADISON ST
CROWN POINT IN
46307-8210
US

V. Phone/Fax

Practice location:
  • Phone: 219-779-0509
  • Fax: 219-738-6714
Mailing address:
  • Phone: 219-779-0509
  • Fax: 219-738-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LYNN MCDONALD
Title or Position: CREDENTIALING
Credential:
Phone: 219-769-1670