| NPI | 1063968584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R. TIMOTHY SHANNON Owner/Therapist 734-649-9989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401010082) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-08-26 |