| NPI | 1104419035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LABBE Credentialing Specialist 231-884-7324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |