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NPI Code Detail

MEDICARE: VALERIE RUNYON BS

MEDICARE: VALERIE RUNYON BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1083168645
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE RUNYON BS
Provider Business Mailing Address
First Line : 909 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-3404
Country : US
Telephone Number : 260-481-2700
Fax Number : 260-481-2838
Provider Business Practice Location Address
First Line : 1115 S MAIN ST
Second Line :
City : BLUFFTON
State : IN
Zip : 46714-3616
Country : US
Telephone Number : 260-824-1071
Fax Number : 260-824-5578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 08/11/2016

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Directions to “ VALERIE RUNYON BS” Practice Location

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