| NPI | 1003389644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LANDRY Interim Director 414-239-9359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-07 |