Provider Demographics
NPI:1013374966
Name:THE FRONT PORCH
Entity Type:Organization
Organization Name:THE FRONT PORCH
Other - Org Name:KBLUMENTRITT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BLUMENTRITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:574-210-8644
Mailing Address - Street 1:515 LINCOLNWAY W
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1808
Mailing Address - Country:US
Mailing Address - Phone:574-210-8644
Mailing Address - Fax:
Practice Address - Street 1:515 LINCOLNWAY W
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1808
Practice Address - Country:US
Practice Address - Phone:574-210-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-23
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000011A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty