| NPI | 1912632621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE TILT Practice Manager 765-490-4808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-07-18 |