| NPI | 1124734058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LARSON Therapist & Owner 331-201-0676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-24 |