| NPI | 1912696451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY MALESA-WHEATON Owner 574-520-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2024-03-12 |