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General NPI Number Information
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NPI Number | 1063646032
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL HEALTH INDIANA, INC.
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1414 N WELLS ST
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City | FORT WAYNE
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State | IN
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Zip | 46808-2796
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Country | US
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Telephone | 208-367-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 N WELLS ST
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City | FORT WAYNE
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State | IN
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Zip | 46808-2796
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Country | US
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Telephone | 260-420-6010
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAY HIGHAM
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Credential |
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Telephone | 214-365-6112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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