| NPI | 1104360734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN W WELLS Owner/Manager 269-759-8750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2016-12-16 |