Provider Demographics
NPI:1154747632
Name:GRET MACHLAN LLC
Entity type:Organization
Organization Name:GRET MACHLAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW LCAC
Authorized Official - Phone:260-203-9059
Mailing Address - Street 1:2200 LAKE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5397
Mailing Address - Country:US
Mailing Address - Phone:260-203-9059
Mailing Address - Fax:260-444-2117
Practice Address - Street 1:2200 LAKE AVE STE 125
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5358
Practice Address - Country:US
Practice Address - Phone:260-203-9059
Practice Address - Fax:260-444-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-08
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health