| NPI | 1003683970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDYN TROCKMAN Co Owner 812-454-7472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 208100000X Physical Medicine & Rehabilitation | |
| 251S00000X | |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |