| NPI | 1174381974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW STACK Owner 989-287-0662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-11 |