| NPI | 1871079459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY SMALLWOOD Credentialing Coordinator 812-853-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 002070) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |