| NPI | 1932493186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD KELLEY Owner 765-914-9116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87000659A) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-05-19 |