| NPI | 1073262036 |
|---|---|
| Doing Business As | NEW AGE THERAPY |
| Entity Type | Organization |
| Authorized Contact | IZAYAH T NEWSOM Owner 574-855-0009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-03-18 |