| NPI | 1205227394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY POLK Clinical Therapist 712-870-1445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1139) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |