| NPI | 1841990686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEEGAN CROCKER Owner 317-992-1988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-07-25 |