| NPI | 1821844192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLIE L FULTZ Owner 317-509-6367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-27 |
| Last Update Date | 2024-04-27 |