| NPI | 1083430557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERI MOORE Executive Director 765-423-6939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-11-29 |
| Last Update Date | 2024-11-29 |