Organization
SOUTH BEND MENTAL HEALTH ASSOCIATES, PC
Active
Other names
South Bend Mental Health Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN H WAX PH.D. (PSYCHOLOGIST/PRESIDENT)
(574) 255-1162
Entity
Organization
Contact information
Practice address
113 LINCOLN WAY E, MISHAWAKA, IN 46544-2016
(574) 255-1162
(574) 233-8002
Mailing address
113 LINCOLN WAY E, MISHAWAKA, IN 46544-2016
(574) 255-1162
(574) 233-8002
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
57000133A
IN
103TC0700X
Clinical Psychologist
57000133A
IN
251S00000X
Community/Behavioral Health Agency
57000133A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368604
ANTHEM
IN
05
—
200021670
—
IN
Enumeration date
07/17/2007
Last updated
06/18/2008
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