| NPI | 1053485771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEESON CLAY MICHAEL Md 913-287-0007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KS 1492141032) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |