| NPI | 1235940586 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | KAILEE PETERSON Office Manager 385-399-0928 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health | 
| Additional Taxonomies | 103T00000X Psychologist | 
| Enumeration Date | 2025-01-16 | 
| Last Update Date | 2025-01-16 |