| NPI | 1013713759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DAWN MOORE Contracting Partner 038-196-5855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-24 |