| NPI | 1023735321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE LYNN FRASER Executive Director 888-455-1642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician | |
| 133V00000X Dietitian, Registered | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2024-04-03 |