| NPI | 1033143722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE A KELLY Credentialing 162-587-6727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 101YM0800X Counselor Mental Health | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-09-25 |