| NPI | 1245924141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER LEWIS TOLLER Owner 667-207-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2023-06-05 |