| NPI | 1235688946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH SLOAN Clinical Director 866-588-0477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC1135) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LCM593) |
| 106H00000X Marriage & Family Therapist (Licence: MD LCM584) | |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2016-09-23 |