| NPI | 1063263697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON CFO 855-380-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker, Clinical | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-08-06 |