| NPI | 1104470665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LAWRENCE THIBAULT Owner/Psychotherapist 267-918-6916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |