| Burry And Smith Counseling Services Inc. | |
|
3266 Mallard Cove Ln Fort Wayne IN 46804-2883 | |
| (260) 436-5986 | |
| (260) 436-5986 |
| Full Name | Burry And Smith Counseling Services Inc. |
|---|---|
| Speciality | Counselor |
| Location | 3266 Mallard Cove Ln, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kim Marie Smith (PRESIDENT) |
| Authorized Official Contact | 2604365986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Burry And Smith Counseling Services Inc. 3266 Mallard Cove Ln Fort Wayne IN 46804-2883 Ph: () - | Burry And Smith Counseling Services Inc. 3266 Mallard Cove Ln Fort Wayne IN 46804-2883 Ph: (260) 436-5986 |
| NPI Number | 1902823891 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4688834328 |
|---|---|
| Medicare Enrollment ID | O20120404000521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902823891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 34002738A (Indiana) | Primary |
| Provider Name | Donald F Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629100128 PECOS PAC ID: 8729249073 Enrollment ID: I20120412000417 |
| Provider Name | Kim M Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558493056 PECOS PAC ID: 4284895533 Enrollment ID: I20120412000437 |
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