Provider Demographics
NPI:1326285495
Name:MIDWEST INSTITUTE OF TRAINING AND DEVELOPMENT
Entity Type:Organization
Organization Name:MIDWEST INSTITUTE OF TRAINING AND DEVELOPMENT
Other - Org Name:KAY GRASK COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:574-292-6553
Mailing Address - Street 1:211 W WASHINGTON ST
Mailing Address - Street 2:STE 1910
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1711
Mailing Address - Country:US
Mailing Address - Phone:574-292-6553
Mailing Address - Fax:574-232-0124
Practice Address - Street 1:211 W WASHINGTON ST
Practice Address - Street 2:STE 1910
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1711
Practice Address - Country:US
Practice Address - Phone:574-292-6553
Practice Address - Fax:574-232-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000195A1041C0700X
IN35000665A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100460830AMedicaid
IN217590BMedicare PIN