| NPI | 1639615206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL A. YOUNG Vice President/Business Administrat 317-520-4650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042335A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001948A) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-04-11 |