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Victory Clinical Services Ii Llc
Nurse Practitioner in South Bend, Indiana
NPI 1497798284

Victory Clinical Services Ii Llc is a Nurse Practitioner based in South Bend, IN. Victory Clinical Services Ii Llc practices in South Bend, IN. The NPI Number for Victory Clinical Services Ii Llc is 1497798284 and holds a License No. 20010221A (Indiana).

The current practice location address for Victory Clinical Services Ii Llc is 4218 W Western Ave, South Bend, IN and can be reached out via phone at 574-233-1524 and via fax at 574-233-1612.

Location: 4218 W Western Ave, South Bend, IN, 46619-2622
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1497798284
Provider Name
Victory Clinical Services Ii Llc
Credential
Provider Entity Type
Organization
Address
4218 W Western Ave, South Bend, IN, 46619-2622
Phone Number
574-233-1524
Fax Number
574-233-1612
Provider Enumeration Date
06/13/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1255432233 01 IN WOODWARD NPC - NPI
168750 05 IN
100220790 05 IN
200495610 05 IN
1518055565 01 IN SHEEHAN HSPP - NPI
1982647434 01 IN WANG - NPI
institution
Provider Business Practice Location Address Details
Address
4218 W Western Ave
City
South Bend
State
Indiana
Zip
46619-2622
Phone Number
574-233-1524
Fax Number
574-233-1612
person
Provider Business Mailing Address Details
Address
4218 W Western Ave
City
South Bend
State
Indiana
Zip
46619-2622
Phone Number
574-233-1524
Fax Number
574-233-1612
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Health Service
Taxonomy
103TH0100X
License No.
71001833A (Indiana)
Definition
A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Addiction Medicine
Taxonomy
207QA0401X
License No.
02001493A (Indiana)
Definition
A family medicine physician who specializes in the diagnosis and treatment of addictions.
person
Provider's Taxonomy Details 3
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
20010221A (Indiana)
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
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