| NPI | 1104251016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE BLAISE BELOSO Psychologist 317-931-9241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042422A) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |