| NPI | 1194300855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA WILLET Director Of Managed Care 855-711-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2026-09-14 |