| NPI | 1033281084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA S. ELLISON Administrative Director 641-856-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2008-07-24 |