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General NPI Number Information
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NPI Number | 1336300359
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Entity Type | Organization
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Legal Business Name | VALLE VISTA LLC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 898 E MAIN ST
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City | GREENWOOD
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State | IN
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Zip | 46143-1407
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Country | US
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Telephone | 317-887-1348
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Fax | 317-885-9063
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Provider Business Mailing Address
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Address Line | 898 E MAIN ST
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City | GREENWOOD
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State | IN
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Zip | 46143-1407
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Country | US
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Telephone | 317-887-1348
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Fax | 317-885-9063
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Authorized Official
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Title or Position | CEO
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Name | MR. GLENN DAVID BELL JR.
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Credential |
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Telephone | 317-887-1348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3071PIP
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License Number State | IN
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