| NPI | 1043620925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PORTIA BONEBRAKE Sole Member 425-449-9710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WA 60097435) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |