| NPI | 1790225332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANICA M MCCLENDON Licensed Clinical Therapist 317-588-6538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IN 34004024-A) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |