Provider Demographics
NPI:1417083460
Name:SAMARITAN COUNSELING CENTERS, INC
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTERS, INC
Other - Org Name:SAMARITAN COUNSELIN CENTERS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-879-3283
Mailing Address - Street 1:340 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3374
Mailing Address - Country:US
Mailing Address - Phone:219-879-3283
Mailing Address - Fax:219-879-6965
Practice Address - Street 1:340 COMMERCE SQ
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3288
Practice Address - Country:US
Practice Address - Phone:219-879-3283
Practice Address - Fax:219-879-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization