| NPI | 1174280002 |
|---|---|
| Other Name | MYMENTALSPACE.ORG |
| Entity Type | Organization |
| Authorized Contact | KELLY MICHAEL BASSHAM CEO 248-986-2991 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-11-28 |
| Last Update Date | 2021-11-28 |