Healthcare Provider Details

I. General information

NPI: 1063646032
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTH INDIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N WELLS ST
FORT WAYNE IN
46808-2796
US

IV. Provider business mailing address

1414 N WELLS ST
FORT WAYNE IN
46808-2796
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-9446
  • Fax:
Mailing address:
  • Phone: 260-420-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAY HIGHAM
Title or Position: CEO
Credential:
Phone: 214-365-6112