| NPI | 1093571275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA NELSON Owner 667-910-4615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SP0807X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent | |
| 364SP0809X Clinical Nurse Specialist Psychiatric/Mental Health, Adult | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-06-26 |