| Behavior Services & Therapy | |
|
912 E Lasalle Ave South Bend IN 46617-2817 | |
| (574) 231-8000 | |
| (574) 231-8013 |
| Full Name | Behavior Services & Therapy |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 912 E Lasalle Ave, South Bend, Indiana |
| Authorized Official Name and Position | Robin Buchanan (OFFICE MANAGER) |
| Authorized Official Contact | 5742318000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavior Services & Therapy 912 E Lasalle Ave South Bend IN 46617-2817 Ph: (574) 231-8000 | Behavior Services & Therapy 912 E Lasalle Ave South Bend IN 46617-2817 Ph: (574) 231-8000 |
| NPI Number | 1659555852 |
|---|---|
| Provider Enumeration Date | 12/24/2007 |
| Last Update Date | 03/03/2023 |
| Certification Date | 03/25/2022 |
| Medicare PECOS PAC ID | 0648644641 |
|---|---|
| Medicare Enrollment ID | O20230314001788 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659555852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Bradley S Mazick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518933779 PECOS PAC ID: 4789764184 Enrollment ID: I20230314000221 |
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