| NPI | 1487741633 |
|---|---|
| Doing Business As | AT THE WELL |
| Entity Type | Organization |
| Authorized Contact | DAVID ANTHONY SOPER President 317-626-2462 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040752A) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IN 57000107A) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IN 20040752A) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IN 20040752A) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2010-07-16 |