| NPI | 1033702196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M BRADLEY Owner 458-206-0337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2024-01-25 |