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General NPI Number Information
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NPI Number | 1154747632
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Entity Type | Organization
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Legal Business Name | GRET MACHLAN LLC
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Dates
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Enumeration Date | 03/08/2014
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 2200 LAKE AVE STE 125
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City | FORT WAYNE
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State | IN
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Zip | 46805-5358
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Country | US
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Telephone | 260-203-9059
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Fax | 260-444-2117
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Provider Business Mailing Address
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Address Line | 2200 LAKE AVE SUITE 125
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City | FORT WAYNE
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State | IN
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Zip | 46805-5397
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Country | US
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Telephone | 260-203-9059
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Fax | 260-444-2117
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Authorized Official
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Title or Position | OWNER / CLINICIAN
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Name | MARGARET A MACHLAN
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Credential | MSW LCSW LCAC
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Telephone | 260-203-9059
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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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