| NPI | 1295923795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDIE GATES Credentialing Specialist 937-609-7830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 4487) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2011-09-12 |