| NPI | 1962195131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA LOCKETT Co Owner 260-348-4738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-06-08 |