| NPI | 1053688812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN S. MINNICK Owner/Partner 317-847-1645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001215A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000930A) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2011-11-22 |