| NPI | 1942998273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LYNN MALESA-WHEATON Single Member LLC Owner 574-520-8444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2024-03-12 |