Organization
ST MARGARET MERCY HEALTHCARE CENTERS
Active
Other names
St Margaret Mercy Behavioral Health Outpatient Centers
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
5500 HOHMAN AVE, SUITE 3A, HAMMOND, IN 46320-1942
(219) 852-2513
(218) 852-2443
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2251
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100462480I
—
IN
01
—
90000854
BCBSIL
IL
Enumeration date
11/06/2006
Last updated
02/04/2011
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