| NPI | 1073270252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZABETH RYAN MCGOUGH Executive Director 877-467-7310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2021-11-22 |