| NPI | 1245955087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY JENSON CEO 385-352-9696 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2024-10-14 |