| NPI | 1235098815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY JONES Owner 475-302-6515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 251S00000X Community/Behavioral Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2026-01-19 |
| Last Update Date | 2026-01-19 |