| NPI | 1225865082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY MALLORY Director 740-815-4739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2025-08-19 |