| NPI | 1154827129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN L MOORE Therapist 574-529-5090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005489A) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2018-03-30 |