| NPI | 1114607140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL BOYLE Director, Cred 737-600-6039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2026-08-27 |