| Northeastern Center | |
|
220 S Main St Kendallville IN 46755-1718 | |
| (260) 347-2453 | |
| (260) 347-2456 |
| Full Name | Northeastern Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 220 S Main St, Kendallville, Indiana |
| Authorized Official Name and Position | Jeryl Hollister (CEO) |
| Authorized Official Contact | 2603472453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeastern Center Po Box 817 Kendallville IN 46755-0817 Ph: (260) 347-2453 | Northeastern Center 220 S Main St Kendallville IN 46755-1718 Ph: (260) 347-2453 |
| NPI Number | 1720140908 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 02/21/2017 |
| Medicare PECOS PAC ID | 6709795636 |
|---|---|
| Medicare Enrollment ID | O20040605000289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720140908 | NPI | - | NPPES |
| 100190820A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 426-0-CMHC (Indiana) | Primary |
| Provider Name | Samir Gamal Ishak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548257488 PECOS PAC ID: 4880655331 Enrollment ID: I20041019001023 |
| Provider Name | Manuel S Ozoa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881686020 PECOS PAC ID: 2264496405 Enrollment ID: I20041117000162 |
| Provider Name | Connie A Ramos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376651711 PECOS PAC ID: 5294778783 Enrollment ID: I20050606000835 |
| Provider Name | Suzanne K Sprague |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891803235 PECOS PAC ID: 8325957251 Enrollment ID: I20070503000478 |
| Provider Name | Susan W Schneider |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508838657 PECOS PAC ID: 9234185620 Enrollment ID: I20090218000123 |
| Provider Name | Larry H Lambertson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124019005 PECOS PAC ID: 1153467659 Enrollment ID: I20091014000576 |
| Provider Name | Amy K Scheeringa |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1033369897 PECOS PAC ID: 4587846688 Enrollment ID: I20110310000701 |
| Provider Name | Lauren A Laroe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154672806 PECOS PAC ID: 1153573910 Enrollment ID: I20121201000013 |
| Provider Name | Teresa J Greiner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003834128 PECOS PAC ID: 3375595275 Enrollment ID: I20131002000195 |
| Provider Name | Shelley C Lafferty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871963504 PECOS PAC ID: 7214296037 Enrollment ID: I20180123003163 |
| Provider Name | Deborah Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205173309 PECOS PAC ID: 3971863481 Enrollment ID: I20180201000582 |
| Provider Name | Nicholas J Todoran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003369273 PECOS PAC ID: 8628325933 Enrollment ID: I20180718000987 |
| Provider Name | Zachary L Kyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104294180 PECOS PAC ID: 4789919176 Enrollment ID: I20190708001034 |
| Provider Name | Fransetta L Sterling |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306285556 PECOS PAC ID: 1254612633 Enrollment ID: I20190924001130 |
| Provider Name | Wendy Bodwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356957641 PECOS PAC ID: 5799196002 Enrollment ID: I20201117002723 |
| Provider Name | Jennifer L Motz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679691380 PECOS PAC ID: 6901206218 Enrollment ID: I20210608001966 |
| Provider Name | Cory Headley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740909332 PECOS PAC ID: 4486039286 Enrollment ID: I20220914003289 |
| Provider Name | Shea Alana Sechman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992395982 PECOS PAC ID: 3173925336 Enrollment ID: I20230814001343 |
| Provider Name | Jeremy D Lewis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447492673 PECOS PAC ID: 4486004702 Enrollment ID: I20231229000230 |
| Provider Name | Suzann Marie Doran |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1164695136 PECOS PAC ID: 0345479507 Enrollment ID: I20240126003226 |
| Provider Name | Jana I Hernandez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902489560 PECOS PAC ID: 3476996786 Enrollment ID: I20240202003384 |
| Provider Name | Susan Kamara |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841512886 PECOS PAC ID: 3375986615 Enrollment ID: I20240203000279 |
| Provider Name | Thomas J Carder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467471466 PECOS PAC ID: 0042653842 Enrollment ID: I20240208002764 |
| Provider Name | Teresa Christ |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598938565 PECOS PAC ID: 5395188866 Enrollment ID: I20240212003218 |
| Provider Name | Patricia Luckey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972388429 PECOS PAC ID: 2264877190 Enrollment ID: I20240229003622 |
The Missing Piece Aba Therapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6365 N 400 E, Kendallville, IN 46755 Phone: 260-336-3350 | |
Northeastern Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 S Main St, Kendallville, IN 46755 Phone: 260-347-2453 Fax: 260-347-2456 | |
J M-turner, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1847 Ida Red Rd, Kendallville, IN 46755 Phone: 260-582-2251 Fax: 260-230-3529 | |
Allied Physicians Inc., D/b/a Fort Wayne Neurology Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 951 Hospital Dr, Kendallville, IN 46755 Phone: 888-737-9311 | |
Northeastern Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 S Main St, Kendallville, IN 46755 Phone: 260-347-2453 Fax: 260-347-2456 | |
Northeastern Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 S Main St, Kendallville, IN 46755 Phone: 260-347-2453 Fax: 260-347-2456 |