Organization
MAINSTAY MUSIC THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON THOMAS MT-BC (CEO/OWNER)
(260) 494-1624
Entity
Organization
Contact information
Practice address
10812 COLDWATER RD STE 400, FORT WAYNE, IN 46845-1204
(260) 409-8246
Mailing address
1910 SAINT JOE CENTER RD STE 44, FORT WAYNE, IN 46825-5000
(260) 494-1624
(260) 494-1624
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201028040 A
MEDICAID WAIVER LEGACY NUMBER
IN
Enumeration date
01/22/2016
Last updated
09/14/2023
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