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General NPI Number Information
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NPI Number | 1104514512
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Entity Type | Organization
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Legal Business Name | JOYFUL ALEGRIA LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/29/2023
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Provider Practice Location Address
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Address Line | 2545 BLAKE RD
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City | PORTAGE
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State | IN
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Zip | 46368-1817
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Country | US
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Telephone | 219-413-1817
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 BLAKE RD
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City | PORTAGE
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State | IN
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Zip | 46368-1817
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Country | US
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Telephone | 219-413-1817
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | YOLANDA CASILLAS
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Credential | PHD
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Telephone | 219-487-4388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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