| Southlake Community Mental Health Center Inc. | |
|
8555 Taft St Merrillville IN 46410-6123 | |
| (219) 769-4005 | |
| (219) 769-0620 |
| Full Name | Southlake Community Mental Health Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 8555 Taft St, Merrillville, Indiana |
| Authorized Official Name and Position | Robert Krumwied (PRESIDENT/CEO) |
| Authorized Official Contact | 2197571970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Community Mental Health Center Inc. 8400 Louisiana St Merrillville IN 46410-6385 Ph: (219) 757-1928 | Southlake Community Mental Health Center Inc. 8555 Taft St Merrillville IN 46410-6123 Ph: (219) 769-4005 |
| NPI Number | 1821081290 |
|---|---|
| Provider Enumeration Date | 08/31/2005 |
| Last Update Date | 06/18/2009 |
| Medicare PECOS PAC ID | 5991600355 |
|---|---|
| Medicare Enrollment ID | O20031201000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821081290 | NPI | - | NPPES |
| 100157670A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kenya S Everette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205021268 PECOS PAC ID: 3072415496 Enrollment ID: I20040311000057 |
| Provider Name | Charles F Motley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316948789 PECOS PAC ID: 2365491982 Enrollment ID: I20050823000339 |
| Provider Name | Prakash Varghese |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356336192 PECOS PAC ID: 7012942717 Enrollment ID: I20050930000705 |
| Provider Name | Oleh Dzera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255348371 PECOS PAC ID: 5991726044 Enrollment ID: I20051216000115 |
| Provider Name | Hugh B Starks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548206527 PECOS PAC ID: 0941196455 Enrollment ID: I20081229000054 |
| Provider Name | Vanessa A Urban |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538236864 PECOS PAC ID: 0648288340 Enrollment ID: I20090327000260 |
| Provider Name | Smitha Patibandla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154580918 PECOS PAC ID: 8426194069 Enrollment ID: I20091012000465 |
| Provider Name | Winifred H Mycka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073837365 PECOS PAC ID: 9032247341 Enrollment ID: I20100506000860 |
| Provider Name | Sujittra Niyakorn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306067392 PECOS PAC ID: 8729117270 Enrollment ID: I20100521000743 |
| Provider Name | John S Kern |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083615454 PECOS PAC ID: 6002872868 Enrollment ID: I20100527000502 |
| Provider Name | Jose L Ramirez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114927142 PECOS PAC ID: 4981899242 Enrollment ID: I20101111001153 |
| Provider Name | Harrison Dai |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1962585398 PECOS PAC ID: 5799964573 Enrollment ID: I20110126000057 |
| Provider Name | Joseph Fanelli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205962495 PECOS PAC ID: 2860560208 Enrollment ID: I20120712000536 |
| Provider Name | Elizabeth A Garcia Janis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417987231 PECOS PAC ID: 7315080983 Enrollment ID: I20130423000127 |
| Provider Name | Warren J Fournier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992770580 PECOS PAC ID: 8022032564 Enrollment ID: I20130510000528 |
| Provider Name | Kobie I Douglas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497850663 PECOS PAC ID: 2860458536 Enrollment ID: I20131115000035 |
| Provider Name | Marcialee Ledbetter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164492567 PECOS PAC ID: 0840288445 Enrollment ID: I20140509001669 |
| Provider Name | Krishn Mohan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346440989 PECOS PAC ID: 1951497411 Enrollment ID: I20150910002180 |
| Provider Name | Tawny E Avila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932461696 PECOS PAC ID: 1951529635 Enrollment ID: I20160321001324 |
| Provider Name | Lolita O Ang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548536196 PECOS PAC ID: 2567761133 Enrollment ID: I20160503001371 |
| Provider Name | Rujuta Gandhi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437180346 PECOS PAC ID: 3072519602 Enrollment ID: I20160615001231 |
| Provider Name | Harold Crew Mason |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265692057 PECOS PAC ID: 3274709696 Enrollment ID: I20160701000528 |
| Provider Name | Shaylice M Meserole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912372350 PECOS PAC ID: 9032409057 Enrollment ID: I20170307000641 |
| Provider Name | Annalaura Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093088379 PECOS PAC ID: 5890079032 Enrollment ID: I20170307000728 |
| Provider Name | Michelle M Peters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235468570 PECOS PAC ID: 7618230319 Enrollment ID: I20180411000605 |
| Provider Name | Arlene Angela Paden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093876534 PECOS PAC ID: 2264429265 Enrollment ID: I20180430002473 |
| Provider Name | Archana Barry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609878545 PECOS PAC ID: 3173411337 Enrollment ID: I20180628001231 |
| Provider Name | Priyanka Sarihan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205241130 PECOS PAC ID: 7012219405 Enrollment ID: I20181108002768 |
| Provider Name | Janee S Ware |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952692816 PECOS PAC ID: 4981921038 Enrollment ID: I20190426000955 |
| Provider Name | Lee V Patterson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700905981 PECOS PAC ID: 4981767308 Enrollment ID: I20190507001738 |
| Provider Name | John E Smolnicky |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508010042 PECOS PAC ID: 4688964455 Enrollment ID: I20201006002428 |
| Provider Name | David Michael Greer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992903470 PECOS PAC ID: 8426478579 Enrollment ID: I20201012002315 |
| Provider Name | Truptiben Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275067225 PECOS PAC ID: 9931517257 Enrollment ID: I20210426001184 |
| Provider Name | Christina Stanga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073502555 PECOS PAC ID: 7911955745 Enrollment ID: I20210915000806 |
| Provider Name | Joon W Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609397066 PECOS PAC ID: 5991079683 Enrollment ID: I20210921000668 |
| Provider Name | Donna Zloza |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154529840 PECOS PAC ID: 6901987130 Enrollment ID: I20211007000169 |
| Provider Name | Stephen Cates |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679076012 PECOS PAC ID: 0143639328 Enrollment ID: I20230120001427 |
| Provider Name | Bishoy Barsoum |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659908986 PECOS PAC ID: 4880058312 Enrollment ID: I20230915002137 |
| Provider Name | Rachel Marie Santay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720616105 PECOS PAC ID: 4587010533 Enrollment ID: I20231026002703 |
| Provider Name | Bishoy Barsoum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659908986 PECOS PAC ID: 4880058312 Enrollment ID: I20240313001914 |
| Provider Name | Catherine Wong |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1629082755 PECOS PAC ID: 3779873500 Enrollment ID: I20250310000377 |
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