| NPI | 1225623069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JADORA BREAL PARKS Owner 502-296-6734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2022-06-17 |