Provider Demographics
NPI:1841248754
Name:INTRIGUE COUNSELING, INC
Entity type:Organization
Organization Name:INTRIGUE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ABBEE
Authorized Official - Middle Name:DALLEK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-234-3515
Mailing Address - Street 1:227 N DIXIE WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3385
Mailing Address - Country:US
Mailing Address - Phone:574-234-3515
Mailing Address - Fax:574-234-3565
Practice Address - Street 1:227 N DIXIE WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3385
Practice Address - Country:US
Practice Address - Phone:574-234-3515
Practice Address - Fax:574-234-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000672A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375890AMedicaid
IN200375890AMedicaid