Organization
MIND BODY AUTISM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERI KRAKOVICH PHD (OWNER)
(201) 452-6613
Entity
Organization
Contact information
Practice address
12354 HANCOCK ST, CARMEL, IN 46032-5807
(201) 452-6613
Mailing address
11831 HARVARD LN, CARMEL, IN 46032-4663
(201) 452-6613
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
04/05/2018
Last updated
04/05/2018
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