| NPI | 1205659554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH LAKE Licensed Mental Health Counselor 574-298-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |