| Riverside Trauma Services | |
|
2250 Lake Ave Ste 170 Fort Wayne IN 46805-5357 | |
| (260) 376-2242 | |
| Not Available |
| Full Name | Riverside Trauma Services |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2250 Lake Ave Ste 170, Fort Wayne, Indiana |
| Authorized Official Name and Position | Ellen Shannon (MEMBER) |
| Authorized Official Contact | 2602713889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Trauma Services 2250 Lake Ave Ste 170 Fort Wayne IN 46805-5357 Ph: (260) 376-2242 | Riverside Trauma Services 2250 Lake Ave Ste 170 Fort Wayne IN 46805-5357 Ph: (260) 376-2242 |
| NPI Number | 1376421453 |
|---|---|
| Provider Enumeration Date | 08/26/2025 |
| Last Update Date | 08/26/2025 |
| Certification Date | 08/26/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376421453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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