| NPI | 1356005599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH RYAN BAIRD Manager 574-202-7115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2023-03-28 |