| NPI | 1306897004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS BIGELOW Director Enterprise Credentialing & 260-266-1403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IN 419-0-CMHC) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-10-29 |