Organization
CCABA
Active
Organization
CCABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KIRKLAND (BT)
(219) 386-1975
Entity
Organization
Contact information
Practice address
501 WALL ST, VALPARAISO, IN 46383-2537
(317) 960-4052
Mailing address
2900 COUNTY LINE RD, LAKE STATION, IN 46405-2745
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/15/2026
Last updated
01/15/2026
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