Provider Demographics
NPI:1982631164
Name:ASSOCIATES IN BEHAVIORAL COUNSELING PC
Entity Type:Organization
Organization Name:ASSOCIATES IN BEHAVIORAL COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANNATTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD HSPP
Authorized Official - Phone:765-288-1110
Mailing Address - Street 1:4607 N WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304
Mailing Address - Country:US
Mailing Address - Phone:765-288-1110
Mailing Address - Fax:765-288-4044
Practice Address - Street 1:4607 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-288-1110
Practice Address - Fax:765-288-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000299446OtherBLUE CROSS BS ANTHEM
000000299446OtherBLUE CROSS BS ANTHEM