| NPI | 1598535288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIAN M ELLIS Provider Engagement & Credentialing 765-540-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-11-07 |