| NPI | 1104703636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLAUS JOHNSON Owner 262-751-7119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-09-24 |