| NPI | 1093362840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB M BOUNDS Clinical Director 877-338-2725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2022-01-05 |