| NPI | 1235878299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANKLAN Owner 385-202-6104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2025-12-29 |