| NPI | 1073106415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LYNETTE COLLINS Owner 249-755-2463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2021-02-18 |