Healthcare Provider Details

I. General information

NPI: 1437983103
Provider Name (Legal Business Name): GRANT-BLACKFORD MENTAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N WABASH AVE
MARION IN
46952-2608
US

IV. Provider business mailing address

505 N WABASH AVE
MARION IN
46952-2608
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-3971
  • Fax:
Mailing address:
  • Phone: 765-662-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STACY HAYES
Title or Position: WORKFLOW ANALYST & CREDENTIALING
Credential:
Phone: 765-667-8520