| NPI | 1164913786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR RILEY Account Manager 267-909-8264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-05-21 |