| NPI | 1053296905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE JACKSON Pmhnp/President 317-493-6456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-08-09 |
| Last Update Date | 2025-08-09 |