| NPI | 1073561882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CHRISTOPHER Contracting & Credentialing COO R 563-327-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health | |
| 251S00000X Community/Behavioral Health | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-05-01 |