| NPI | 1104616762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEENA SCOTT Owner 267-259-3481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2025-05-07 |