Provider Demographics
NPI:1972241925
Name:BAY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:BAY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:260-242-6643
Mailing Address - Street 1:312 OLD BOG RD
Mailing Address - Street 2:
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46710-9458
Mailing Address - Country:US
Mailing Address - Phone:260-242-6643
Mailing Address - Fax:
Practice Address - Street 1:10331 DAWSONS CREEK BLVD STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1908
Practice Address - Country:US
Practice Address - Phone:260-525-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty