| NPI | 1124637236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMALIA E SULLIVAN Owner 541-203-6703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2020-07-24 |