| NPI | 1508304023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KRESS Business Manager 317-912-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20042014A) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2020-01-09 |