| NPI | 1154039196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACH JENSON CEO 385-352-9746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2024-10-14 |