| NPI | 1831873801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRETCHEN SHISSLER Executive Director 765-414-0125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |