| Globe Star, LLC | |
|
621 Broadway Chesterton IN 46304-2259 | |
| (219) 921-5492 | |
| (219) 921-0143 |
| Full Name | Globe Star, LLC |
|---|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
| Location | 621 Broadway, Chesterton, Indiana |
| Authorized Official Name and Position | Anthony Michael Mccrovitz (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2199215492 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Globe Star, LLC 621 Broadway Chesterton IN 46304-2259 Ph: (219) 921-5492 | Globe Star, LLC 621 Broadway Chesterton IN 46304-2259 Ph: (219) 921-5492 |
| NPI Number | 1912922550 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 09/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912922550 | NPI | - | NPPES |
| 100110700 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | () | Secondary |
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | 100110700 (Indiana) | Primary |
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