| NPI | 1255815874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETIENNE CLATANOFF Clinical Consultant 1 913-302-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 208D00000X General Practice | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2018-09-19 |