| Trinity Faith-based University | |
|
839 Broadway Suite 104 Gary IN 46402-2414 | |
| (219) 882-4010 | |
| (219) 882-0210 |
| Full Name | Trinity Faith-based University |
|---|---|
| Speciality | Psychologist - Health Service |
| Location | 839 Broadway, Gary, Indiana |
| Authorized Official Name and Position | Darcelmarie Smith (PRESIDENT) |
| Authorized Official Contact | 2198824010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Faith-based University 839 Broadway Suite 104 Gary IN 46402-2414 Ph: (219) 882-4010 | Trinity Faith-based University 839 Broadway Suite 104 Gary IN 46402-2414 Ph: (219) 882-4010 |
| NPI Number | 1124436936 |
|---|---|
| Provider Enumeration Date | 07/24/2014 |
| Last Update Date | 07/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124436936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | 20041768A (Indiana) | Primary |
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