| NPI | 1215637434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASSO ERIC RUSAMAZA CEO 920-378-7176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103K00000X Behavior Analyst | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-10 |