| NPI | 1083587059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE KENNETH BERTRAND Owner 715-201-4542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-09-25 |
| Last Update Date | 2025-09-25 |