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NPI Code Detail

MEDICARE: VAN'S CONSULTING SERVICES, P.C.

MEDICARE: VAN'S CONSULTING SERVICES, P.C.
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
11041C0700XClinical Social Worker34003564AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000341875OTHERINANTHEM BCBS
2030305OTHERINMHN TRICARE
37733638OTHERINAETNA

General Provider Information

NPI Number : 1548472764
Entity Type Code : Organization
Provider Name (Legal Business Name) : VAN'S CONSULTING SERVICES, P.C.
Provider Business Mailing Address
First Line : 1415 MAGNAVOX WAY
Second Line : SUITE 120
City : FORT WAYNE
State : IN
Zip : 46804-1565
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1415 MAGNAVOX WAY
Second Line : SUITE 120
City : FORT WAYNE
State : IN
Zip : 46804-1565
Country : US
Telephone Number : 260-471-7800
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MS. TAMARA LYNNE VANBAALEN
Credential : LCSW
Telephone Number : 260-471-7800
Provider Enumeration Date : 05/03/2007
Last Update Date : 08/22/2020

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