| NPI | 1073091856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE YVONNE LIZARDI Medicaid Billing Specialist Ii 614-227-9430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2022-11-30 |