| NPI | 1073153607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLISHA RILEY Executive Director 419-508-6434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-01-11 |
| Last Update Date | 2020-02-01 |