| Comprehensive Behavioral Services, Llc | |
|
2809 E Dupont Rd Fort Wayne IN 46825-1668 | |
| (260) 492-5500 | |
| (260) 492-5530 |
| Full Name | Comprehensive Behavioral Services, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2809 E Dupont Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Gayle Bevill-dada (PRESIDENT/COO) |
| Authorized Official Contact | 2604925500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Behavioral Services, Llc 2809 E Dupont Rd Fort Wayne IN 46825-1668 Ph: (260) 492-5500 | Comprehensive Behavioral Services, Llc 2809 E Dupont Rd Fort Wayne IN 46825-1668 Ph: (260) 492-5500 |
| NPI Number | 1023221207 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 06/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023221207 | NPI | - | NPPES |
| 100332280 | Medicaid | IN | |
| 1023221207 | Medicaid | IN | |
| 1053488197 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39001423A (Indiana) | Primary |
| 103TC1900X | Psychologist - Counseling | 2004070712A (Indiana) | Secondary |
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