| NPI | 1043721954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARICELJEAN RYCRAFT Administrator 702-665-6869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2022-09-07 |