| NPI | 1093447757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA BACKMAN Owner 385-313-0547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2024-01-08 |