| NPI | 1982493607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SHAKE CEO 317-474-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-05-01 |