| NPI | 1982415873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISSA CHISM BUGGS Medical Director 574-444-0256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2025-01-18 |
| Last Update Date | 2025-01-18 |