| NPI | 1205484052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN MAE MENDYK Business Office Manager 989-401-8916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2019-09-20 |