Provider Demographics
NPI: | 1619448834 |
---|---|
Name: | CENTER FOR PROBLEM RESOLUTION |
Entity Type: | Organization |
Organization Name: | CENTER FOR PROBLEM RESOLUTION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHELLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOEFLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, LCAC, LMHC |
Authorized Official - Phone: | 574-294-7447 |
Mailing Address - Street 1: | 211 S 5TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ELKHART |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46516-2834 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 574-294-7447 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 211 S 5TH ST |
Practice Address - Street 2: | |
Practice Address - City: | ELKHART |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46516-2834 |
Practice Address - Country: | US |
Practice Address - Phone: | 574-294-7447 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CENTER FOR PROBLEM RESOLUTION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-12-16 |
Last Update Date: | 2018-12-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |