| NPI | 1023146792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND KYLE BAYNE Mental Health Therapist Iii 313-382-7861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2011-08-30 |