Individual
JEFFREY R STUDEBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC, LCSW, LCAC
Contact information
Practice address
6202 CONSTITUTION DR, SUITE D, FORT WAYNE, IN 46804-1583
(260) 432-0066
(260) 432-8503
Mailing address
6202 CONSTITUTION DR, SUITE D, FORT WAYNE, IN 46804-1583
(260) 432-0066
(260) 432-8503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001434A
IN
101YM0800X
Mental Health Counselor
39000242A
IN
1041C0700X
Clinical Social Worker
Primary
33002281A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200912670A
—
IN
Enumeration date
03/13/2013
Last updated
03/13/2013
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