Healthcare Provider Details

I. General information

NPI: 1063560456
Provider Name (Legal Business Name): ADAPTIVE BEHAVORIAL COUNSELING RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 COMMODORE LN
PORTER IN
46304-9571
US

IV. Provider business mailing address

1420 COMMODORE LN
PORTER IN
46304-9571
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-2244
  • Fax: 303-296-1709
Mailing address:
  • Phone: 303-296-2244
  • Fax: 303-296-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040651A
License Number StateIN

VIII. Authorized Official

Name: WALTER D MUNN
Title or Position: OWNER
Credential: PHD
Phone: 303-296-2244