Healthcare Provider Details

I. General information

NPI: 1952852105
Provider Name (Legal Business Name): LPA CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 VALPARAISO ST SUITE 209
VALPARAISO IN
46383-3329
US

IV. Provider business mailing address

2005 VALPARAISO ST SUITE 209
VALPARAISO IN
46383-3329
US

V. Phone/Fax

Practice location:
  • Phone: 219-252-5464
  • Fax: 219-728-1860
Mailing address:
  • Phone: 219-252-5464
  • Fax: 219-728-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIN

VIII. Authorized Official

Name: MS. HOLLIE MARIE MOKRZYCKI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 219-252-5464