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1112 Route 41 Suite 108 Shererville IN 46375 | |
(219) 613-0332 | |
Not Available |
Full Name | |
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Speciality | Social Worker - Clinical |
Location | 1112 Route 41, Shererville, Indiana |
Authorized Official Name and Position | Kelly Mucha (CLINICAL SOCIAL WORKER) |
Authorized Official Contact | 2196130332 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1112 Route 41 Suite 108 Shererville IN 46375 Ph: (219) 613-0332 | 1112 Route 41 Suite 108 Shererville IN 46375 Ph: (219) 613-0332 |
NPI Number | 1568819126 |
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Provider Enumeration Date | 05/24/2016 |
Last Update Date | 05/24/2016 |
Identifier | Type | State | Issuer |
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1568819126 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | 99072105A. (Indiana) | Primary |