Organization
GLOBE STAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY MICHAEL MCCROVITZ (EXECUTIVE DIRECTOR)
(219) 921-5492
Entity
Organization
Contact information
Practice address
621 BROADWAY, CHESTERTON, IN 46304-2259
(219) 921-5492
(219) 921-0143
Mailing address
621 BROADWAY, CHESTERTON, IN 46304-2259
(219) 921-5492
(219) 921-0143
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
100110700
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110700
—
IN
Enumeration date
07/13/2006
Last updated
09/15/2008
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