Organization
EDGEWATER SYSTERMS FOR BALANCED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS MICHAEL BUCKNER MA,NCC (THERAPIST II)
(219) 885-4264
Entity
Organization
Contact information
Practice address
1106 WEST 6 TH AVENUE, GARY, IN 46402
(219) 885-4264
(219) 885-1332
Mailing address
1106 WEST 6 TH AVENUE, GARY, IN 46402
(219) 885-4264
(219) 885-1332
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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