| NPI | 1922605864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLA JOYCE CANNON YEARWOOD Owner 317-402-1604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-05 |