Provider Demographics
NPI:1962651091
Name:HAMBRIGHT AND ASSOCIATES INC
Entity Type:Organization
Organization Name:HAMBRIGHT AND ASSOCIATES INC
Other - Org Name:HAMBRIGHT AND ASSOCIATES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SHIRK
Authorized Official - Last Name:HAMBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:574-267-2906
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-1323
Mailing Address - Country:US
Mailing Address - Phone:574-267-2906
Mailing Address - Fax:574-269-4646
Practice Address - Street 1:503 E FORT WAYNE ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3338
Practice Address - Country:US
Practice Address - Phone:574-267-2096
Practice Address - Fax:574-269-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN34003096A1041C0700X
IN35000757A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
258900Medicare PIN