| NPI | 1093339624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN SHIPLEY Co Clinical Director 267-567-3378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-05-29 |