Healthcare Provider Details

I. General information

NPI: 1215940374
Provider Name (Legal Business Name): AMH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W JACKSON ST
MUNCIE IN
47304-4371
US

IV. Provider business mailing address

3111 W JACKSON ST
MUNCIE IN
47304-4371
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-0879
  • Fax: 765-284-1480
Mailing address:
  • Phone: 765-284-0879
  • Fax: 765-284-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. CEOLA D BERRY
Title or Position: CLINICAL DIRECTOR
Credential: PHD, HSPP
Phone: 765-284-0879