| NPI | 1134372741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNAH DEVAULT Licensed Clinical Social Worker 765-532-0569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005290A) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |