| NPI | 1073176426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLIN BEATTY CEO 339-368-7696 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2019-05-30 |