| NPI | 1114738499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER RENEE GOOLSBY Master Clinicican 517-581-4710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |