| NPI | 1831804400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALKIN SHELAT COO 574-402-8736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-01-18 |