| Great Lakes Behavioral Services | |
|
701 N Niles Ave South Bend IN 46617-1923 | |
| (574) 393-9955 | |
| (574) 393-9956 |
| Full Name | Great Lakes Behavioral Services |
|---|---|
| Speciality | Behavior Analyst |
| Location | 701 N Niles Ave, South Bend, Indiana |
| Authorized Official Name and Position | Shanti Bradley (CO-CLINICAL DIRECTOR) |
| Authorized Official Contact | 5743939955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Behavioral Services 701 N Niles Ave Ste Op102 South Bend IN 46617-1923 Ph: (574) 393-9955 | Great Lakes Behavioral Services 701 N Niles Ave South Bend IN 46617-1923 Ph: (574) 393-9955 |
| NPI Number | 1144818295 |
|---|---|
| Provider Enumeration Date | 01/05/2021 |
| Last Update Date | 06/28/2021 |
| Certification Date | 06/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144818295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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