| NPI | 1467114702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE GRAFF Contracting & Credentialing Manager 317-376-8336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2021-10-13 |