| NPI | 1194529065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE RENNER Owner 701-400-9042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-05-01 |