| NPI | 1124809389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIERRA BUSH Owner 225-993-3021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |