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General NPI Number Information
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NPI Number | 1760909840
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Entity Type | Organization
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Legal Business Name | PRECIOUS PALS INC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1139 E LASALLE AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-3321
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Country | US
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Telephone | 574-386-9757
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Fax | 574-246-9578
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Provider Business Mailing Address
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Address Line | 1139 E LASALLE AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-3321
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Country | US
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Telephone | 574-386-9757
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Fax | 574-246-9578
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Authorized Official
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Title or Position | PROGRAM DIRECTOR / COUNSELOR
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Name | MS. TINA RENEE BYNUM
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Credential | B.A., A.A.
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Telephone | 574-386-9757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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