| NPI | 1063172195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC OLIVARES Owner 737-708-7417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2023-08-02 |