| NPI | 1720524762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONITA LEE STREETMAN Clinical Counselor 317-446-4125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IN 34002619A) |
| Additional Taxonomies | 251S00000X (Licence: IN 87000793A) |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2017-01-14 |