Healthcare Provider Details

I. General information

NPI: 1366492043
Provider Name (Legal Business Name): VON BARGEN ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SAINT JOE CENTER RD SUITE 44
FORT WAYNE IN
46825-5000
US

IV. Provider business mailing address

1910 SAINT JOE CENTER RD SUITE 44
FORT WAYNE IN
46825-5000
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-8033
  • Fax: 260-471-8107
Mailing address:
  • Phone: 260-471-8033
  • Fax: 260-471-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL J HAUSCHILD
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 260-471-8033