| NPI | 1174858963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA SUE GORDY Owner 641-856-2688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IA 01294) |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2021-05-06 |