| NPI | 1649243759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN PERRY CEO 219-766-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: IN 5180909873540) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: IN 73540) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 73540) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 73540) | |
| 103TF0000X Psychologist, Family (Licence: IN 73540) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IN 73540) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 73540) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: IN 50266819873831) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 5180909873540) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2012-07-03 |