| NPI | 1174387708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVA ARCHIE Program Amin 502-409-4357 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 174400000X Specialist | |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-02-13 |