| NPI | 1053880856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BENJAMIN JAMES JEIDER Owner 702-350-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2025-03-28 |