| NPI | 1548833619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE GRAFF Contracting/Credentialing Manager 317-376-8336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 103TH0100X Psychologist, Health Service | |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2021-07-19 |