| NPI | 1104022649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC STEPHEN SIRAK Cats1 541-409-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-07-21 |