| NPI | 1275794869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT MOORADIAN Psychologist 219-836-3101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040803) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2009-03-17 |