| NPI | 1598504060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT RYAN GIVENS Owner 260-413-7333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-05-23 |