| NPI | 1063180222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOLINA Credentialing Leader 888-878-8595 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2025-07-21 |