| NPI | 1164139366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRY SCHUMACHER Sr. Director Provider Services 800-400-6354 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2022-10-28 |