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General NPI Number Information
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NPI Number | 1922550268
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Entity Type | Individual
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Provider Name | MR. AMBROSE RESA JR.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 2037 US HIGHWAY 41
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2801
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Country | US
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Telephone | 219-595-0281
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Fax | 219-595-0288
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Provider Business Mailing Address
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Address Line | 2037 US HIGHWAY 41
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2801
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Country | US
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Telephone | 219-595-0281
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Fax | 219-595-0288
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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 | 178.012351
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39004060A
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License Number State | IN
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