| NPI | 1932937596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE OTIS Manager 317-517-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2024-07-24 |