| NPI | 1639285232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY W. ELLIOTT President 574-254-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IN 57000021A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 57000021A) |
| 103TC0700X Psychologist Clinical (Licence: IN 57000021A) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IN 57000021A) | |
| 103TR0400X Psychologist Rehabilitation (Licence: IN 57000021A) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2013-02-27 |