Provider Demographics
NPI:1649243759
Name:UHS THE MIDWEST CENTER FOR YOUTH & FAMILIES
Entity Type:Organization
Organization Name:UHS THE 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 N. 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:2006-02-09
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5180909873540101YM0800X, 322D00000X
IN73540103TC0700X, 103TC2200X, 103TF0000X, 103TP2701X, 2084P0800X, 323P00000X
IN50266819873831323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200465920AMedicaid