| NPI | 1073497574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEE MACK Np Owner 463-363-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-08-05 |
| Last Update Date | 2026-03-18 |