Organization
MIDWEST ADDICTION PSYCHIATRIC & PSYCHOLOGICAL SERVICES LLC
Active
Other names
MAPPS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DON A MARSHALL JR. M.D. (OWNER)
(260) 456-7261
Entity
Organization
Contact information
Practice address
3010 E. STATE BLVD, STE 100, FORT WAYNE, IN 46805
(260) 471-0632
(260) 471-3451
Mailing address
3010 E STATE BLVD, SUTIE A, FORT WAYNE, IN 46805-4700
(260) 471-0632
(260) 471-3451
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14060ASO
IN
101YM0800X
Mental Health Counselor
14060ASO
IN
103T00000X
Psychologist
14060ASO
IN
103TA0400X
Addiction (Substance Use Disorder) Psychologist
14060ASO
IN
103TB0200X
Cognitive & Behavioral Psychologist
14060ASO
IN
103TC2200X
Clinical Child & Adolescent Psychologist
14060ASO
IN
103TF0200X
Forensic Psychologist
14060ASO
IN
1041C0700X
Clinical Social Worker
14060ASO
IN
106H00000X
Marriage & Family Therapist
14060ASO
IN
2084P0800X
Psychiatry Physician
14060ASO
IN
2084P0802X
Addiction Psychiatry Physician
14060ASO
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200200260A
—
IN
Enumeration date
05/15/2006
Last updated
03/02/2018
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