Organization
JAY BASTIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY ALAN BASTIAN LCSW (PSYCHOTHERAPIST)
(260) 418-9653
Entity
Organization
Contact information
Practice address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 418-9653
Mailing address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 418-9653
(260) 209-0762
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34007970A
IN
Other
Enumeration date
02/20/2018
Last updated
10/26/2024
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