| NPI | 1184433450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE L LOGAN Contracts And Licensing Specialist 583-440-5791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106S00000X Behavior Technician | |
| 163W00000X Registered Nurse | |
| 164W00000X Licensed Practical Nurse | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2025-01-02 |
| Last Update Date | 2025-01-02 |