| NPI | 1215332028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE LYNN BUCKLEY Social Worker 262-501-0770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 7921) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2014-10-23 |