| NPI | 1093017196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JEFFREY LOGAN Owner/President 262-786-1710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 16418-20) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2010-11-22 |