Robert Balliet, MSW
Individual provider Active NPI Counselor · Mishawaka, IN
NPI 1710550603 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1710550603
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1411 Lincolnway W
Mishawaka, IN 46544-1626 - Phone
- (574) 533-1234
- Fax
- (574) 537-2652
- NPI assigned
- Jul 20, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1411 Lincolnway W
Mishawaka, IN 46544-1626
Mailing address
PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234
Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.