| NPI | 1043926306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERANDA SHANTEL MURPHY Credentialing Agent 740-856-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-01-30 |