| NPI | 1447660295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENAI DANELLE TIDWELL Owner 317-523-9275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 69448) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2014-05-02 |