| NPI | 1740780204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY ALAN BASTIAN Psychotherapist 260-418-9653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007970A) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2024-10-26 |