| Marillac Counseling, Llc | |
|
4630 W Jefferson Blvd Ste 3 Fort Wayne IN 46804-6800 | |
| (260) 222-6367 | |
| (260) 235-5328 |
| Full Name | Marillac Counseling, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4630 W Jefferson Blvd Ste 3, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kathy Massonne (OWNER) |
| Authorized Official Contact | 2602226367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marillac Counseling, Llc 5112 Indiana Ave Fort Wayne IN 46807-3026 Ph: (260) 222-6367 | Marillac Counseling, Llc 4630 W Jefferson Blvd Ste 3 Fort Wayne IN 46804-6800 Ph: (260) 222-6367 |
| NPI Number | 1033783766 |
|---|---|
| Provider Enumeration Date | 05/17/2021 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033783766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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