Provider Demographics
NPI:1578583910
Name:PSYCHIATRIC INNOVATIONS PC
Entity Type:Organization
Organization Name:PSYCHIATRIC INNOVATIONS PC
Other - Org Name:FAWVER WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FAWVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-436-4060
Mailing Address - Street 1:6920 POINTE INVERNESS WAY
Mailing Address - Street 2:#250
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7926
Mailing Address - Country:US
Mailing Address - Phone:260-436-4060
Mailing Address - Fax:260-436-5713
Practice Address - Street 1:6920 POINTE INVERNESS WAY
Practice Address - Street 2:#250
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7926
Practice Address - Country:US
Practice Address - Phone:260-436-4060
Practice Address - Fax:260-436-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty