| NPI | 1114666161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONELLE ENSIGN Owner 321-305-4342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2022-05-28 |