| NPI | 1891553889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SU MYAHLA ROTH License Clinical Social Worker 317-775-4994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-03-13 |