Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1467667733 |
---|---|
Provider Name | Andrew R. Guljas |
First Address | South Bend, IN 46619-2617 |
Second Address | South Bend, IN 46619-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 13/05/2015 |