| NPI | 1821369836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY FEATHERGILL Director 574-282-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041616A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IN 20041616A) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: IN 20041616A) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 2041616A) | |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2016-07-06 |