| NPI | 1659513935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE RAE BAUTISTA Clinical Director 317-240-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN C973) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-04-01 |