| NPI | 1275124737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE THARASRI Manager 323-419-3869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2023-06-29 |