| NPI | 1285203620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY A O'SHEA Owner 331-315-1271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2024-02-20 |