Healthcare Provider Details

I. General information

NPI: 1134782626
Provider Name (Legal Business Name): GOSHEN CITY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N 5TH ST
GOSHEN IN
46528-3226
US

IV. Provider business mailing address

66208 GRASSLANDS LN
GOSHEN IN
46526-7323
US

V. Phone/Fax

Practice location:
  • Phone: 267-980-9785
  • Fax:
Mailing address:
  • Phone: 267-980-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: HOLLI ELIZABETH PERRIN
Title or Position: PRESIDENT
Credential: BCBA
Phone: 267-980-8785