| NPI | 1215748934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER STEPHENS Owner 786-200-7553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2026-01-12 |