| NPI | 1053112268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ELISABETH KIRK Owner 740-776-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-08-01 |