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General NPI Number Information
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NPI Number | 1871607168
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Entity Type | Individual
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Provider Name | ANNA M BLACK M.S.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 106 THREE RIVERS N
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City | FORT WAYNE
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State | IN
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Zip | 46802-1312
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Country | US
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Telephone | 260-426-5778
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Fax | 260-423-6412
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Provider Business Mailing Address
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Address Line | 106 THREE RIVERS NORTH
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City | FORT WAYNE
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State | IN
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Zip | 46802
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Country | US
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Telephone | 260-426-5778
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Fax | 260-423-6412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 39000048
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License Number State | IN
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