Healthcare Provider Details

I. General information

NPI: 1972322402
Provider Name (Legal Business Name): ANDREA BONTRAGER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 3RD ST
GOSHEN IN
46526-3709
US

IV. Provider business mailing address

17 FAIRFIELD PARK
GOSHEN IN
46526-1518
US

V. Phone/Fax

Practice location:
  • Phone: 574-535-0880
  • Fax: 574-535-0882
Mailing address:
  • Phone: 574-971-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA JOAN BONTRAGER
Title or Position: CEO
Credential: MA,LCSW,LMSW
Phone: 574-971-1246