Healthcare Provider Details

I. General information

NPI: 1659153757
Provider Name (Legal Business Name): BMM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53846 GENERATIONS DR
SOUTH BEND IN
46635-1543
US

IV. Provider business mailing address

11621 ROUND OAK DR
GRANGER IN
46530-8847
US

V. Phone/Fax

Practice location:
  • Phone: 574-596-7090
  • Fax:
Mailing address:
  • Phone: 574-596-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BAYLEY MORSE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 574-596-7090