| NPI | 1144803735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN JAMES CARLSON Medical Director, Owner 360-605-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2021-04-30 |