| NPI | 1528335924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL S ANGEVINE President 502-641-5989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IN 34001748A) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2011-11-29 |