| NPI | 1235610445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SCOTT THOMPSON Therapist 385-312-0440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 9151068-0160) |
| Enumeration Date | 2018-08-25 |
| Last Update Date | 2018-08-25 |