Individual provider Active NPI

Amani Khalil, PHD, HSPP

  • Clinical Psychologist
  • Fort Wayne, IN
National Provider Identifier
1144045568
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20043876A Issued in IN
Practice address
2100 Goshen Rd
Fort Wayne, IN 46808-1493
Phone
(260) 471-3500
NPI assigned
Nov 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 20043876A IN Primary

Addresses

Primary practice location

2100 Goshen Rd
Fort Wayne, IN 46808-1493

Mailing address

2621 E Jefferson St
Warsaw, IN 46580-3880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241205000921 IN Practitioner - Clinical Psychologist 9234665977 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20043876AINMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bowen Health Inc Current Accepting new patients
Khalil Psychological Services Clinical Current Accepting new patients
Center for Neurobehavioral Services Inc CurrentSince Apr 7, 2025 Accepting new patients
Bowen Health Inc CurrentSince Sep 22, 2024 Accepting new patients

Locations

2100 Goshen Rd
Fort Wayne, IN 46808
Phone (260) 471-3500

3010 E State Blvd
Fort Wayne, IN 46805
Phone (260) 471-2300

2621 E Jefferson St
Warsaw, IN 46580
Phone (574) 269-0573

850 N Harrison St
Warsaw, IN 46580
Phone (219) 267-7169

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1144045568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 E JEFFERSON ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 GOSHEN RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468081493",
            "telephone_number": "260-471-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "AMANI",
        "credential": "PHD, HSPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043876A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.