| NPI | 1356114672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH COOK Managing Member 317-207-0765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-11-13 |