| Tailoring Minds Llc | |
|
3822 Vance Ave Fort Wayne IN 46805-1642 | |
| (260) 348-0463 | |
| Not Available |
| Full Name | Tailoring Minds Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3822 Vance Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Latoya Mckinney (OWER) |
| Authorized Official Contact | 2603480463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tailoring Minds Llc 3822 Vance Ave Fort Wayne IN 46805-1642 Ph: (260) 348-0463 | Tailoring Minds Llc 3822 Vance Ave Fort Wayne IN 46805-1642 Ph: (260) 348-0463 |
| NPI Number | 1396524435 |
|---|---|
| Provider Enumeration Date | 09/27/2023 |
| Last Update Date | 03/04/2024 |
| Certification Date | 03/04/2024 |
| Medicare PECOS PAC ID | 4284073586 |
|---|---|
| Medicare Enrollment ID | O20240419000901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396524435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Greta Lavon Mckinney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396057626 PECOS PAC ID: 7719326016 Enrollment ID: I20240419001144 |
| Provider Name | Sylvia Wade |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477835049 PECOS PAC ID: 1254772528 Enrollment ID: I20240517000706 |
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