| NPI | 1073114823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN LAPTEV President 754-217-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2020-11-06 |