| NPI | 1174649552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER RICHARD DESMANGLES Clinical Coordinator 765-742-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001705A) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |