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 | 103TB0200X Psychologist Cognitive & Behavioral (Licence: IN 20040752A) |
103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: IN 57000107A) | |
103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: IN 20040752A) | |
Enumeration Date | 2006-10-09 |
Last Update Date | 2010-07-16 |