| NPI | 1861874869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD EDWARDS Owner/President 574-855-7169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IN 20042553A) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IN 20042553A) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042553A) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20042553A) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-06-25 |