| NPI | 1225448798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY J GORDER Owner 701-201-0076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 569121506190) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |