| NPI | 1235754292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA Y LELLO Owner 074-310-4485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QV0200X Clinic/Center, VA | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2021-06-17 |