| NPI | 1912418880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN JEROME MALONE CEO 219-629-9053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39003046A) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |