NPI | 1295335446 |
---|---|
Entity Type | Organization |
Authorized Contact | JENNIFER MORA Director Of Billing 219-850-4084 |
Organization Subpart ? | Yes |
Primary Taxonomy | 251S00000X |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2020-10-27 |
Last Update Date | 2020-10-27 |