| NPI | 1164179610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN TUCKER Program Manager 559-355-0089 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-03-04 |