| NPI | 1700196698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL ROBERT GOLDSTEIN Owner 574-532-0153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-18 |