| NPI | 1164714721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA JANICAK Executive Director 877-553-9440 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2022-09-28 |