| NPI | 1477885432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY G BLOSSOM Chief Executive Officer 765-668-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: IN 15546093333447) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001934A) |
| 104100000X Social Worker (Licence: IN 33001688A) | |
| 1041C0700X Social Worker, Clinical (Licence: IN 34002547A) | |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000968A) | |
| 106H00000X Marriage & Family Therapist (Licence: IN 35001283A) | |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2010-02-02 |