| Family & Childrens Service Of Fort Wayne Inc | |
|
2712 S Calhoun St Fort Wayne IN 46807-1402 | |
| (260) 744-4326 | |
| (260) 744-0188 |
| Full Name | Family & Childrens Service Of Fort Wayne Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2712 S Calhoun St, Fort Wayne, Indiana |
| Authorized Official Name and Position | Stephen A Jarrell (EXECUTIVE DIRECTOR CEO) |
| Authorized Official Contact | 2607444326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family & Childrens Service Of Fort Wayne Inc 2712 S Calhoun St Fort Wayne IN 46807-1402 Ph: () - | Family & Childrens Service Of Fort Wayne Inc 2712 S Calhoun St Fort Wayne IN 46807-1402 Ph: (260) 744-4326 |
| NPI Number | 1699820720 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 09/07/2017 |
| Medicare PECOS PAC ID | 4587625769 |
|---|---|
| Medicare Enrollment ID | O20041021000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699820720 | NPI | - | NPPES |
| 200090360 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8020ASR (Indiana) | Primary |
| Provider Name | Ronald J Furniss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962540203 PECOS PAC ID: 4688848682 Enrollment ID: I20111130000546 |
| Provider Name | Stephen A Jarrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528105202 PECOS PAC ID: 3476514654 Enrollment ID: I20181004001916 |
| Provider Name | Jade M Milliman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215693924 PECOS PAC ID: 4082005608 Enrollment ID: I20211215001314 |
| Provider Name | Vanessa L Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144664574 PECOS PAC ID: 1759734478 Enrollment ID: I20240130001401 |
| Provider Name | Paige L Zehr |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134731425 PECOS PAC ID: 4688027311 Enrollment ID: I20240130001735 |
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