| NPI | 1912530361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TA'VONYA A BUSH Manager 317-572-0238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 101YS0200X Counselor, School | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 106S00000X Behavior Technician | |
| 251B00000X Case Management | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-02-13 |