| NPI | 1053695932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JO NIBBS Owner 317-545-4202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |