| NPI | 1750723490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE CLARK Managing Member 765-366-4621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103T00000X Psychologist |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2020-07-15 |