| NPI | 1912157140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAX CHARLES BLANKENBURG Executive Director 317-575-9855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000813A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001869A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000794A) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2008-09-24 |