| NPI | 1013673482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN RICHARDS Owner 346-285-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2021-11-10 |