| NPI | 1215458138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE ELIZABETH BERGAN Clinical Social Worker 574-269-5829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: IN 34007808A) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2019-10-09 |