| NPI | 1609685049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEE GAGE Lcsw 574-304-1804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2024-12-31 |