| NPI | 1093335929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ELIZABETH SHORT Owner 971-273-8668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |