NPI | 1013424100 |
---|---|
Other Name | LEGAL BUSINESS NAME |
Entity Type | Organization |
Authorized Contact | TIMOTHY JEIDER Owner 702-350-2906 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
Enumeration Date | 2018-01-10 |
Last Update Date | 2022-03-17 |