| NPI | 1518580141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUANNE LARUE Licsw 419-563-7984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |