MEDICARE: STRESS OPERATIONS GROUP, INC

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
1	101YM0800X	Mental Health Counselor	34003766	IN

General Provider Information

NPI Number	:	1760485395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRESS OPERATIONS GROUP, INC

Provider Business Mailing Address
First Line	:	5800 FAIRFIELD AVE
Second Line	:	STE 210
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3417
Country	:	US
Telephone Number	:	260-744-0602
Fax Number	:	260-745-5191

Provider Business Practice Location Address
First Line	:	5800 FAIRFIELD AVE
Second Line	:	STE 210
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3417
Country	:	US
Telephone Number	:	260-744-0602
Fax Number	:	260-745-5191

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MR. RICK RITTER
Credential	:	MSW, LCSW, ACSW
Telephone Number	:	260-744-0602

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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