Provider Demographics
NPI:1891482485
Name:DVP COUNSELING AND BEHAVIORAL SERVICES , LLC
Entity Type:Organization
Organization Name:DVP COUNSELING AND BEHAVIORAL SERVICES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIVIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MSW,LSW
Authorized Official - Phone:219-661-2602
Mailing Address - Street 1:9370 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2275
Mailing Address - Country:US
Mailing Address - Phone:219-730-6582
Mailing Address - Fax:
Practice Address - Street 1:9370 TYLER ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2275
Practice Address - Country:US
Practice Address - Phone:219-730-6582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300059112Medicaid