| NPI | 1356731228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEANNE CARLSON Clinical Psychologist 317-431-0897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20040653A) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2015-02-19 |