| NPI | 1285928176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATH HERBERT FERVIDA Owner 574-534-2161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042483A) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2011-06-08 |