| NPI | 1629653902 |
|---|---|
| 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 | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-03-17 |