Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003209065 |
---|---|
Provider Name | Robert Monroe |
First Address | Indianapolis, IN 46254-2094 |
Second Address | Indianapolis, IN 46254-2094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2015 |
Last Update Date | 13/03/2015 |