Healthcare Provider Details

I. General information

NPI: 1558794206
Provider Name (Legal Business Name): FRANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N DIXIE WAY SUITE 135
SOUTH BEND IN
46637-3369
US

IV. Provider business mailing address

219 N DIXIE WAY SUITE 135
SOUTH BEND IN
46637-3369
US

V. Phone/Fax

Practice location:
  • Phone: 574-220-2649
  • Fax: 574-271-3740
Mailing address:
  • Phone: 574-220-2649
  • Fax: 574-271-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3400659A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01037643A
License Number StateIN

VIII. Authorized Official

Name: MS. FRANCES MARIE TOUHEY
Title or Position: PRESIDENT
Credential: LCSW
Phone: 574-229-8863