Healthcare Provider Details

I. General information

NPI: 1962192955
Provider Name (Legal Business Name): ADJUSTING REALITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E MISHAWAKA RD LOT 37
ELKHART IN
46517-2395
US

IV. Provider business mailing address

855 E MISHAWAKA RD LOT 37
ELKHART IN
46517-2395
US

V. Phone/Fax

Practice location:
  • Phone: 574-226-4985
  • Fax:
Mailing address:
  • Phone: 574-226-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: EMILY JOHNS
Title or Position: OWNER
Credential:
Phone: 574-226-4985