| NPI | 1194575472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 855-380-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker, Clinical | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 207Q00000X Family Medicine | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-08-06 |