| NPI | 1245998798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATREASE R MOORE Co Owner 317-985-0173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2021-12-08 |