| NPI | 1912417601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M WYATT Owner 219-929-6205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001619A) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-10-06 |