| NPI | 1194120097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEATRICE RENEE BROOKS Psychologist 866-232-5389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6301015072) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2019-06-11 |