Provider Demographics
NPI:1215940374
Name:AMH, INC
Entity type:Organization
Organization Name:AMH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CEOLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSPP
Authorized Official - Phone:765-284-0879
Mailing Address - Street 1:3111 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4371
Mailing Address - Country:US
Mailing Address - Phone:765-284-0879
Mailing Address - Fax:765-284-1480
Practice Address - Street 1:3111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4371
Practice Address - Country:US
Practice Address - Phone:765-284-0879
Practice Address - Fax:765-284-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000183437OtherANTHEM BCBS
IN000000183437OtherANTHEM BCBS
IN209020Medicare UPIN
IN945500Medicare UPIN