| NPI | 1508213844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE JOHNSON PROSSER Sole Proprietor 574-850-8486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040993) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-17 |