Organization Name: | BURNHAM WOODS COUNSELING NORTH INC |
NPI Number: | 1760537757 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MEDEA LAUREL WOODS (PRESIDENT) |
Mailing Address: | 1977 Highway 250 Rising Sun |
State: | IN US |
Postal Code: | 470409550 |
Phone Number: | 8125942868 |
Fax Number: | 8125942868 |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 20041772A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |