| 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 |