| NPI | 1104553999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAITLIN SPECK Owner 458-281-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2022-11-09 |