Healthcare Provider Details

I. General information

NPI: 1194991778
Provider Name (Legal Business Name): BEHAVIOR SPECIALISTS OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611A CHICAGO ST
VALPARAISO IN
46383-6111
US

IV. Provider business mailing address

2611A CHICAGO ST
VALPARAISO IN
46383-6111
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-6705
  • Fax: 219-464-4318
Mailing address:
  • Phone: 219-462-6705
  • Fax: 219-464-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number20041239
License Number StateIN

VIII. Authorized Official

Name: ROBERT R. SCHNEIDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-462-6705