| NPI | 1124722293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA SHEPEL Contracting Manager 425-214-9321 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |