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>> Marriage & Family Therapist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1174956759

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
201 JEANS DR  SALEM, IN 47167-9200 US
Tel: 812-883-4877  Fax: --

Contact information for business:
402 E MARKET ST  SALEM, IN 47167-2122 US
Tel: --  Fax: --

Registration Information:
NPI: 1174956759
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist

Legacy codes, insurance codes and state license numbers:



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