| NPI | 1215592209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL L VALBURG Sole Member 570-877-3140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-06-08 |