| NPI | 1205128956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORENE GAYLE BURKE Manager 858-383-4286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: KY 3298) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |