| Hickory Grove Behavioral Services, Llc | |
|
101 W 18th St La Porte IN 46350-6830 | |
| (574) 265-4428 | |
| Not Available |
| Full Name | Hickory Grove Behavioral Services, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 101 W 18th St, La Porte, Indiana |
| Authorized Official Name and Position | Robert Dale Owens (OWNER) |
| Authorized Official Contact | 5742654428 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hickory Grove Behavioral Services, Llc 265 S Federal Hwy Ste 429 Deerfield Beach FL 33441-4161 Ph: (574) 265-4428 | Hickory Grove Behavioral Services, Llc 101 W 18th St La Porte IN 46350-6830 Ph: (574) 265-4428 |
| NPI Number | 1962218305 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962218305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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