| NPI | 1235666017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLES D TONNACLIFF Licesed Psychologist Owner 262-618-2856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 2163-57) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |