Provider Demographics
NPI:1174078893
Name:FONTHILL BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:FONTHILL BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:DANZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC
Authorized Official - Phone:812-727-0722
Mailing Address - Street 1:221 E KIRKWOOD AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-3559
Mailing Address - Country:US
Mailing Address - Phone:812-727-0722
Mailing Address - Fax:
Practice Address - Street 1:221 E KIRKWOOD AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-3559
Practice Address - Country:US
Practice Address - Phone:812-727-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty