Provider Demographics
NPI:1881147635
Name:ADVENTURES IN LEARNING
Entity type:Organization
Organization Name:ADVENTURES IN LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:REBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-471-9902
Mailing Address - Street 1:1910 SAINT JOE CENTER RD
Mailing Address - Street 2:OFFICE #63
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5000
Mailing Address - Country:US
Mailing Address - Phone:260-471-9902
Mailing Address - Fax:260-471-9902
Practice Address - Street 1:1910 SAINT JOE CENTER RD
Practice Address - Street 2:OFFICE #63
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-471-9902
Practice Address - Fax:260-471-9902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTURES IN LEARNING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty