| NPI | 1063989085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN IHDE Licensed Psychologist 857-241-3711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2020-12-10 |