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FAMILY PSYCHOLOGY OF SOUTH BEND LLC NPI 1083184196


NPI Information

NPI: 1083184196
Provider Name: FAMILY PSYCHOLOGY OF SOUTH BEND LLC
Classification: Psychologist - 103TF0000X
Entity Type: Organization

Specialization: Family

Address:
922 E WAYNE ST STE 205
SOUTH BEND, IN
ZIP 46617
Phone: (574) 280-8199
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FAMILY PSYCHOLOGY OF SOUTH BEND LLC is a family psychologist in South Bend, IN. The provider is a psychologist whose specialty is founded on principles of systems theory with the interpersonal system of the family the focus of assessment, intervention and research. FAMILY PSYCHOLOGY OF SOUTH BEND LLC NPI is 1083184196. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

922 E WAYNE ST STE 205
SOUTH BEND, IN
ZIP 46617-024
Phone: (574) 280-8199

The provider's authorized official is John Anthony Petersen .
The authorized official title is Manager and has the following contact phone number (574) 280-8199.

The enumeration date for this NPI number is 12/1/2018 and was last updated on 12/1/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YM0800XCounselorMental HealthNo
2103TC0700XPsychologistClinicalNo
31041C0700XSocial WorkerClinicalNo
4103TF0000XPsychologistFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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