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General NPI Number Information
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NPI Number | 1538028634
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Entity Type | Organization
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Legal Business Name | CCABA
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 501 WALL ST
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City | VALPARAISO
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State | IN
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Zip | 46383-2537
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Country | US
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Telephone | 317-960-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 COUNTY LINE RD
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City | LAKE STATION
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State | IN
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Zip | 46405-2745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BT
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Name | MARY KIRKLAND
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Credential |
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Telephone | 219-386-1975
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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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