| Life And Trauma Survivor Center Llc | |
|
402 Wall St Ste 42 Valparaiso IN 46383-2572 | |
| (219) 510-8043 | |
| (219) 241-8044 |
| Full Name | Life And Trauma Survivor Center Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 402 Wall St Ste 42, Valparaiso, Indiana |
| Authorized Official Name and Position | Sherrie Ann Shivok (OWNER) |
| Authorized Official Contact | 2192410212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life And Trauma Survivor Center Llc 402 Wall St Ste 42 Valparaiso IN 46383-2572 Ph: (219) 510-8043 | Life And Trauma Survivor Center Llc 402 Wall St Ste 42 Valparaiso IN 46383-2572 Ph: (219) 510-8043 |
| NPI Number | 1619432119 |
|---|---|
| Provider Enumeration Date | 02/08/2019 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619432119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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