Healthcare Provider Details

I. General information

NPI: 1457702599
Provider Name (Legal Business Name): NEW DAWN BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 BAYARD PARK DR STE 202
EVANSVILLE IN
47714-0602
US

IV. Provider business mailing address

PO BOX 3817
EVANSVILLE IN
47736-3817
US

V. Phone/Fax

Practice location:
  • Phone: 812-202-6311
  • Fax:
Mailing address:
  • Phone: 812-629-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number99073631A
License Number StateIN

VIII. Authorized Official

Name: LYNETTE DAWN MAY
Title or Position: OWNER
Credential:
Phone: 812-629-9785