| 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 |