| NPI | 1255025862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY NIBO Chief Operating Officer 310-484-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-06-06 |