| NPI | 1285966796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLARD J FREDERICK Owner 765-288-7939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34001033A) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2010-02-08 |