Provider Demographics
NPI:1124727672
Name:PIAZZA COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:PIAZZA COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:260-209-4262
Mailing Address - Street 1:4317 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6319 MUTUAL DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4246
Practice Address - Country:US
Practice Address - Phone:260-209-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty