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General NPI Number Information
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NPI Number | 1720816432
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Entity Type | Organization
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Legal Business Name | VICTORY BAY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 8445 KEYSTONE XING STE 180
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-0020
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Country | US
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Telephone | 856-454-3104
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Fax |
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Provider Business Mailing Address
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Address Line | 7 EVES DR STE 100
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City | MARLTON
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State | NJ
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Zip | 08053-3196
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Country | US
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Telephone | 856-282-5590
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REGULATORY COMPLIANCE &
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Name | JENNIFER MELLON
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Credential |
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Telephone | 856-282-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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