| NPI | 1083503825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL M LAZO President 424-488-6422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2025-06-28 |
| Last Update Date | 2025-07-08 |