| NPI | 1114695889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN MUCINO MARTINEZ Sr Credentialing Specialist 888-588-8995 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2023-10-20 |