| NPI | 1245011477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR HANSON Owner 385-209-4524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |