| NPI | 1396497392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE GRAFF Credentialing & Contracting Manager 317-376-8336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-08-10 |