Provider Demographics
NPI:1386905677
Name:COMPREHENSIVE MENTAL HEALTH SERVICES AND CONSULTIN
Entity type:Organization
Organization Name:COMPREHENSIVE MENTAL HEALTH SERVICES AND CONSULTIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:765-717-2254
Mailing Address - Street 1:1517 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5003
Mailing Address - Country:US
Mailing Address - Phone:765-717-2254
Mailing Address - Fax:
Practice Address - Street 1:1517 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5003
Practice Address - Country:US
Practice Address - Phone:765-717-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002187A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health