| NPI | 1073102372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE GONZALEZ Office Manager 907-600-1684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-06-01 |