Organization
WILLOWGLEN ACADEMY - INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE WARREN MUELLER RN (EXECUTIVE DIRECTOR)
(219) 886-1320
Entity
Organization
Contact information
Practice address
308 E 21ST AVE, GARY, IN 46407-2618
(219) 886-1320
Mailing address
308 E 21ST AVE, GARY, IN 46407-2618
(219) 886-1320
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
53769
IN
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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