| NPI | 1184392375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOLINA Credentialing Leader 888-878-8595 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-07-21 |