Provider Demographics
NPI:1689859621
Name:SAMARITAN BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:SAMARITAN BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:812-754-1660
Mailing Address - Street 1:P.O. BOX 462
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170
Mailing Address - Country:US
Mailing Address - Phone:812-754-1660
Mailing Address - Fax:812-754-1664
Practice Address - Street 1:969 W. MCCLAIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170
Practice Address - Country:US
Practice Address - Phone:812-754-1660
Practice Address - Fax:812-754-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042107A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200073210AMedicaid
IN200073210AMedicaid