| NPI | 1033761713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRIE FREEMAN Credentialing Coordinator 419-720-8571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-16 |