| NPI | 1770247181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SCOTT GRAHAM Office Manager 812-799-0074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2021-10-22 |
| Last Update Date | 2021-11-11 |