| NPI | 1104602952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIMI PETERSON Licensed Professional Counselor 541-801-7596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2024-06-27 |