| NPI | 1467890293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD CHARLES RUSSELL Director 574-583-8055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39002487A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IN 39002487A) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2013-06-14 |