| NPI | 1871784330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY ANN TIMMONS Registered Agent 765-404-6431 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34004910A) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-11-15 |