| NPI | 1235816406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOROUR REZVANI Director 669-222-0692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-06-29 |