LIVING WATERS PEACE CENTER (NPI# 1811450646) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811450646 |
| Entity Type | Organization |
| Organization Name | LIVING WATERS PEACE CENTER |
| Practice Address |
3262 Mallard Cove Ln Ste B Fort Wayne IN 46804-2883 |
| Practice Telephone | 2602301180 |
| Mailing Telephone | 2602301180 |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |
| Authorized Official Name | MRS. TRACY LYNN CAIN (OWNER/MENTAL HEALTH COUNSELOR ASSOC) |
| Authorized Official Telephone | 2602301180 |
| Authorized Official Credential | LMHCA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
3262 MALLARD COVE LN STE B |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-2883 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548881899 | Emily H Cook | Counselor | 2130 Pemberton Dr, Fort Wayne, IN 46805-4628 | 2020-04-28 |
| 1871113274 | At Your Pace Counseling, LLC | Counselor | 6717 Sky Blue Dr, Fort Wayne, IN 46804-4648 | 2020-04-26 |
| 1962049809 | Lynne Beardsley | Counselor | 4630 W Jefferson Blvd Ste 11, Fort Wayne, IN 46804-6856 | 2019-12-10 |
| 1578108767 | Wholistic Wellness Counseling and Consulting LLC | Counselor | 1129 Rivermet Ave, Fort Wayne, IN 46805-4232 | 2019-11-11 |
| 1922654722 | Nicole Conrad | Counselor | 908 Manck Dr, Fort Wayne, IN 46814-8995 | 2019-08-16 |
| 1336794148 | Healing Through Art | Counselor | 3521 Lake Ave # B1, Fort Wayne, IN 46805-5536 | 2019-08-08 |
| 1013578749 | A.w. Holdings, LLC | Counselor | 3900 Hursh Rd, Fort Wayne, IN 46845-9677 | 2019-06-24 |
| 1447718325 | Victoria Lynn Prokop | Counselor | 4656 W Jefferson Blvd Ste 210, Fort Wayne, IN 46804-6884 | 2019-03-09 |
| 1811467632 | Believe Counseling and Consulting | Counselor | 2200 Lake Ave Ste 140, Fort Wayne, IN 46805-5351 | 2018-12-05 |
| 1356819346 | Diane Kaehr | Counselor | 1825 Beacon St, Fort Wayne, IN 46805-4750 | 2018-11-07 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on LIVING WATERS PEACE CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.