Provider Demographics
NPI:1710435094
Name:MID-AMERICA MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:MID-AMERICA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-9200
Mailing Address - Street 1:9335 CALUMET AVE.
Mailing Address - Street 2:STE D
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4176
Mailing Address - Country:US
Mailing Address - Phone:219-836-9200
Mailing Address - Fax:219-836-4200
Practice Address - Street 1:402 WALL ST.
Practice Address - Street 2:STE 23
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2567
Practice Address - Country:US
Practice Address - Phone:219-615-3136
Practice Address - Fax:219-615-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty