Provider Demographics
NPI:1548472764
Name:VAN'S CONSULTING SERVICES, P.C.
Entity type:Organization
Organization Name:VAN'S CONSULTING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:VANBAALEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:260-471-7800
Mailing Address - Street 1:1415 MAGNAVOX WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 MAGNAVOX WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1565
Practice Address - Country:US
Practice Address - Phone:260-471-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003564A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000341875OtherANTHEM BCBS
IN030305OtherMHN TRICARE
IN7733638OtherAETNA