Provider Demographics
NPI:1548359086
Name:BLACK & ASSOCIATES COUNSELING SERVICES INC
Entity type:Organization
Organization Name:BLACK & ASSOCIATES COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:260-426-5778
Mailing Address - Street 1:106 THREE RIVERS N
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1312
Mailing Address - Country:US
Mailing Address - Phone:260-426-5778
Mailing Address - Fax:260-423-6412
Practice Address - Street 1:106 THREE RIVERS N
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1312
Practice Address - Country:US
Practice Address - Phone:260-426-5778
Practice Address - Fax:260-423-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232780Medicare ID - Type Unspecified