Healthcare Provider Details

I. General information

NPI: 1144640582
Provider Name (Legal Business Name): ANXIETY & OCD BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE RD F
MUNSTER IN
46321-1726
US

IV. Provider business mailing address

900 RIDGE RD F
MUNSTER IN
46321-1726
US

V. Phone/Fax

Practice location:
  • Phone: 219-228-7630
  • Fax: 219-228-1083
Mailing address:
  • Phone: 219-228-7630
  • Fax: 219-228-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042623A
License Number StateIN

VIII. Authorized Official

Name: HEATHER CHIK
Title or Position: CLINICAL PSYCHOLOGIST/DIRECTOR
Credential: PH.D.
Phone: 219-228-7630