| NPI | 1134726060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILIAN IKE Np 281-415-3127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| Enumeration Date | 2020-10-04 |
| Last Update Date | 2021-05-14 |