| NPI | 1053160713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RURIC (ANDY) CLESBY ANDERSON Md 483-361-7898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-05-15 |