| NPI | 1164568879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL MASSIE Authorized Official 920-887-8751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2025-06-26 |