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General NPI Number Information
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NPI Number | 1861253742
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Entity Type | Organization
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Legal Business Name | INDIANA ADVANCED PSYCHIATRY
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 7230 ENGLE RD STE 102
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City | FORT WAYNE
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State | IN
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Zip | 46804-2234
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Country | US
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Telephone | 260-888-1378
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Fax | 260-387-6763
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Provider Business Mailing Address
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Address Line | 1700 W BIG BEAVER RD STE 300
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City | TROY
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State | MI
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Zip | 48084-3514
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Country | US
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Telephone | 260-888-1378
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Fax | 260-387-6763
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Authorized Official
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Title or Position | RCM DIRECTOR
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Name | DONNELLE BACON
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Credential |
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Telephone | 810-357-6984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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