| NPI | 1841872082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT RUSSELL DUNEVANT Supervisor And Psychotherapist 219-916-0822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2021-04-27 |