| NPI | 1164198628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTI HERZOG Owner 360-584-8270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-10-05 |