Healthcare Provider Details

I. General information

NPI: 1861744062
Provider Name (Legal Business Name): ASSOCIATED BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 E DUPONT RD
FORT WAYNE IN
46825-1668
US

IV. Provider business mailing address

2809 E DUPONT RD
FORT WAYNE IN
46825-1668
US

V. Phone/Fax

Practice location:
  • Phone: 260-755-1894
  • Fax:
Mailing address:
  • Phone: 260-755-1894
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. AKINLANA DADA
Title or Position: PRESIDENT/COO
Credential:
Phone: 260-755-1894