NPI | 1659565026 |
---|---|
Entity Type | Organization |
Authorized Contact | PHYLLIS M OLSON Owner/President 765-622-7622 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041304A) |
Enumeration Date | 2007-08-29 |
Last Update Date | 2007-10-04 |