Provider Demographics
NPI:1184707556
Name:VIETNAM VETERANS FAMILY ASSISTANCE CENTER
Entity type:Organization
Organization Name:VIETNAM VETERANS FAMILY ASSISTANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-620-8529
Mailing Address - Street 1:723 W CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2974
Mailing Address - Country:US
Mailing Address - Phone:765-288-4015
Mailing Address - Fax:765-288-4047
Practice Address - Street 1:723 W CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-2974
Practice Address - Country:US
Practice Address - Phone:765-288-4015
Practice Address - Fax:765-288-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200311360Medicaid
IN200311360Medicaid