| NPI | 1144423609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUELLYN MAHAN Owner 812-236-9569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: IN 20041149) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20041149) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20041149) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2010-07-30 |