Studebaker, Jeffrey R

Studebaker, Jeffrey R is an individual health care provider with primary practice located at 6202 Constitution Dr Suite D, Fort Wayne IN 46804-1583. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Studebaker, Jeffrey R can be contacted via phone (260) 432-0066.

Contact Information

Primary practice address
6202 Constitution Dr Suite D Fort Wayne IN 46804-1583
Phone: (260) 432-0066
Fax: (260) 432-8503
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 87001434A Indiana
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 39000242A Indiana
Behavioral Health & Social Service Providers / Clinical 1041C0700X 33002281A Indiana

Profile Details

NPI number 1588905715
LBN Legal business name Studebaker, Jeffrey R
Credentials LMHC, LCSW, LCAC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2013
Last updated Mar 13th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588905715 NPPES
Indiana MEDICAID 200912670A

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