| NPI | 1194596064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON NATHAN FORD Board Member 346-842-0424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-01-10 |