| NPI | 1275146458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TSHAUN GRANT Owner 888-980-9166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2021-12-23 |