Provider Demographics
NPI:1811004526
Name:VON BARGEN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:VON BARGEN ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON BARGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-471-8033
Mailing Address - Street 1:1910 SAINT JOE CENTER RD
Mailing Address - Street 2:SUITE 44
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5000
Mailing Address - Country:US
Mailing Address - Phone:260-471-8033
Mailing Address - Fax:260-471-8107
Practice Address - Street 1:1910 SAINT JOE CENTER RD
Practice Address - Street 2:SUITE 44
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-471-8033
Practice Address - Fax:260-471-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000434A101YM0800X
IN35001315A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty