| Jay Bastian Llc | |
|
9329 Illinois Rd Fort Wayne IN 46804-5796 | |
| (260) 418-9653 | |
| Not Available |
| Full Name | Jay Bastian Llc |
|---|---|
| Speciality | Social Worker |
| Location | 9329 Illinois Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jay Alan Bastian (PSYCHOTHERAPIST) |
| Authorized Official Contact | 2604189653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jay Bastian Llc 9329 Illinois Rd Fort Wayne IN 46804-5796 Ph: (260) 418-9653 | Jay Bastian Llc 9329 Illinois Rd Fort Wayne IN 46804-5796 Ph: (260) 418-9653 |
| NPI Number | 1740780204 |
|---|---|
| Provider Enumeration Date | 02/20/2018 |
| Last Update Date | 10/26/2024 |
| Certification Date | 10/26/2024 |
| Medicare PECOS PAC ID | 9931529773 |
|---|---|
| Medicare Enrollment ID | O20201016002711 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740780204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34007970A (Indiana) | Primary |
| Provider Name | Jay A Bastian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912363375 PECOS PAC ID: 0840610689 Enrollment ID: I20201020002847 |
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