| NPI | 1154728301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M WILKINSON CEO 317-710-0354 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MT2806) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2014-12-03 |