| NPI | 1114635711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY M TALLEY Owner 317-590-4572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2022-11-11 |