| NPI | 1235974619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY M. CORNWALL Executive Director 424-350-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106E00000X Assistant Behavior Analyst | |
| 171M00000X Case Manager/Care Coordinator | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-06-27 |