| NPI | 1053821355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE TILMAN Manager 800-913-2615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2026-09-15 |