Provider Demographics
NPI:1619280153
Name:UHS MIDWEST CENTER FOR YOUTH & FAMILIES
Entity Type:Organization
Organization Name:UHS MIDWEST CENTER FOR YOUTH & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-766-2999
Mailing Address - Street 1:P.O. BOX 669
Mailing Address - Street 2:1012 W. INDIANA ST
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9703
Mailing Address - Country:US
Mailing Address - Phone:219-766-2999
Mailing Address - Fax:219-766-2704
Practice Address - Street 1:1012 W. INDIANA ST
Practice Address - Street 2:
Practice Address - City:KOUTS
Practice Address - State:IN
Practice Address - Zip Code:46347-9703
Practice Address - Country:US
Practice Address - Phone:219-766-2999
Practice Address - Fax:219-766-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5180909873540101YM0800X, 103T00000X
IN73540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200465920AMedicaid