| NPI | 1235768250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Manager Provider Enrollment 502-381-3579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103K00000X Behavior Analyst | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2022-04-12 |