Healthcare Provider Details

I. General information

NPI: 1861673709
Provider Name (Legal Business Name): ME AND MY HOUSE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N DETROIT ST
LAGRANGE IN
46761-1111
US

IV. Provider business mailing address

777 N DETROIT ST
LAGRANGE IN
46761-1111
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-3700
  • Fax: 260-463-3600
Mailing address:
  • Phone: 260-463-3700
  • Fax: 260-463-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number35001633A
License Number StateIN

VIII. Authorized Official

Name: MR. LORRIE WATSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 260-463-3700