| NPI | 1174520084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY LYNN MCSTOCKARD Director Of Billing 641-472-1684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 03816) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2013-07-29 |