Bruce Holder, PH.D.
Individual provider Active NPI Mental Health Counselor · Upland, IN
NPI 1639701279 · NPPES record last updated Feb 11, 2020
Key facts
- NPI
- 1639701279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 39000465A (IN)
- Practice address
- 525 S Main St
Upland, IN 46989-9101 - Phone
- (765) 298-9315
- NPI assigned
- Feb 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240305003614 | IN | Practitioner - Mental Health Counselor | 8820433402 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Extended Care Specialists, Inc | Single Specialty | Current |
Accepting new patients |
Locations
3512 Stellhorn Rd
Fort Wayne, IN 46815
8398 Mississippi St
Fl 2
Merrillville, IN 46410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 39000465A | IN | Yes |
Addresses
Primary practice location
525 S Main St
Upland, IN 46989-9101
Mailing address
525 S Main St
Upland, IN 46989-9101
Phone (765) 997-1945
Other providers in Upland, IN
- Lauryn Michelle Farney
- Molly Elizabeth Finnegan
- Kenneth Hackman
- Hand in Hand Companion Care LLC
- Erin L Hewitt
- Indiana University Health Ball Memorial Hospital, Inc.
- Indiana University Health Ball Memorial Physicians, Inc.
- Jacob Shane Kirby
- Lisa E Koontz
- Heidi M Lakanen
All providers in Upland, IN · Mental Health Counselor in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2020. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.