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General NPI Number Information
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NPI Number | 1821335563
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Entity Type | Organization
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Legal Business Name | WALKABOUT LLC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 205 S WALNUT ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6128
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Country | US
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Telephone | 812-671-0057
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Fax | 855-370-1590
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Provider Business Mailing Address
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Address Line | 205 S WALNUT ST ST 17
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City | BLOOMINGTON
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State | IN
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Zip | 47404
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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 | PMHCNS-BC, RN
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Name | MRS. MARY BALLE
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Credential |
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Telephone | 812-671-0057
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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 | 28160285A
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License Number State | IN
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