Provider Demographics
NPI:1548530439
Name:SIBIS COUNSELING CENTER LLC
Entity type:Organization
Organization Name:SIBIS COUNSELING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, EDD, LMHC,
Authorized Official - Phone:219-884-1655
Mailing Address - Street 1:3195 BROADWAY LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-1006
Mailing Address - Country:US
Mailing Address - Phone:219-884-1655
Mailing Address - Fax:219-884-1651
Practice Address - Street 1:3195 BROADWAY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1006
Practice Address - Country:US
Practice Address - Phone:219-884-1655
Practice Address - Fax:219-884-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000758 A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200940750Medicaid