| NPI | 1275010753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVARRES ALEXANDER Chief Executive Officer 980-777-0586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: KY 1144558701) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: KY 1144558701) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: KY 1144558701) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: KY 1144558701) | |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2021-04-20 |