Individual
KERI ELLEN MCCALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3711 RUPP DR STE 208, FORT WAYNE, IN 46815-4523
(260) 217-5902
(260) 202-5202
Mailing address
1514 BOONE ST, FORT WAYNE, IN 46808-3708
(260) 217-5902
(260) 202-5202
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39003263A
IN
101YM0800X
Mental Health Counselor
Primary
88000135A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300065057
—
IN
Enumeration date
06/27/2017
Last updated
12/21/2022
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