| NPI | 1629657465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MICHAEL NOTTINGHAM Clinical Director 317-983-5281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |