| NPI | 1659876126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP DAVID GOOD-ELLIOTT Owner 574-535-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: IN 340004467A) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IN 34004467A) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-03-27 |