| NPI | 1134764509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RUBIO Owner 253-208-3179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-21 |