Aberdeen Group LLC
Organization Active NPI Psychologist · Fort Wayne, IN
NPI 1124302237 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1124302237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- Legal business name
- ABERDEEN GROUP LLC
- Practice address
- 12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016 - Phone
- (260) 373-0880
- Fax
- (260) 373-0881
- NPI assigned
- Oct 7, 2011
- Organization subpart
- No
Authorized official
- Name
- Thomas Dettmer, PSY.D. HSPP
- Title
- Psy.D. HSPP/ Owner
- Phone
- (260) 373-0880
Corporate family (same tax ID) 1
Practitioners 23
-
Thomas Paul Dettmer, PSY.D
-
Kristine Louise Discala, PH.D, HSPP
-
Jason Elliott, MA, LMHC
-
Jill L Hansen, MS, LMFT
-
Chelsea T Jordan, LMHC
-
Andrew James Miller, PSYD, HSPP
-
Tina Marie Parker, LMFT
-
Elizabeth Pictor, LMHC
-
Rachel E Roberts, LCSW
-
Lisa Elaine Sells, LMHCA
-
Gary Younghans, MFT
-
Michelle Heironimus, LMHC
-
Alyson Kline, LMHCA
-
Crystal Lynn McCollister, LMHCA
-
Nicole A Deller, PMHNP
-
Nicole A Langel, LCSW
-
Melisa M Sanchez Landgraf, MS ED., LMFTA
-
Tyler James Zielasko, MA, LMHC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120131000698 | IN | Part B Supplier - Clinic/Group Practice | 5597922757 |
Receives reassigned benefits from 15 practitioners Practice locations: Fort Wayne, IN; Warsaw, IN |
National Provider Directory
- Tax ID family
- Aberdeen Group LLC
Locations
3894 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-0880
12948 Coldwater Rd
Ste 101
Fort Wayne, IN 46845
Phone (260) 373-0880
3804 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-0880
115 Park Ridge Dr
Warsaw, IN 46580
Phone (260) 373-0880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | Yes |
Addresses
Primary practice location
12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016
Mailing address
12948 Coldwater Rd Ste 101
Fort Wayne, IN 46845-8016
Phone (260) 373-0880
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.