| NPI | 1114813904 |
|---|---|
| Former Legal Business Name | MADRONA CLINICS, PLLC |
| Entity Type | Organization |
| Authorized Contact | MICHEAL JACE TARVER CEO 564-206-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-10-06 |