Organization
DEBRA CORN AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJA MUTZL M.A. (MARRIAGE & FAMILY THERAPIST)
(765) 449-1992
Entity
Organization
Contact information
Practice address
200 PROFESSIONAL CT STE A, LAFAYETTE, IN 47905-5134
(765) 479-2409
Mailing address
200 PROFESSIONAL CT STE A, LAFAYETTE, IN 47905-5134
(765) 479-2409
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/14/2010
Last updated
09/14/2010
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