Provider Demographics
NPI:1639657703
Name:WAKABAYASHI, SATOMI (LMHC)
Entity Type:Individual
Prefix:
First Name:SATOMI
Middle Name:
Last Name:WAKABAYASHI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 W TWICKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 S SCATTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1804
Practice Address - Country:US
Practice Address - Phone:765-298-4600
Practice Address - Fax:765-298-4998
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001765A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health