| NPI | 1821124801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NADIA TUCKER Practice Administrator 317-923-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: IN 57000016A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 57000016A) |
| 103T00000X Psychologist (Licence: IN 57000016A) | |
| 103TF0200X Psychologist, Forensic (Licence: IN 57000016A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 57000016A) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 57000016A) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2016-03-03 |