| NPI | 1083184196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANTHONY PETERSEN Manager 574-280-8199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0000X Psychologist Family |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2018-12-01 |
| Last Update Date | 2018-12-01 |