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General NPI Number Information
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NPI Number | 1548780943
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Entity Type | Organization
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Legal Business Name | BPW
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6859 WHITCOMB ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3397
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Country | US
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Telephone | 219-765-8161
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Fax |
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Provider Business Mailing Address
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Address Line | 6859 WHITCOMB ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3397
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Country | US
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Telephone | 219-765-8161
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | TANYA ANNETTE BURNS
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Credential | LCSW
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Telephone | 219-765-8161
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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 | 34007856A
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License Number State | IN
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