| NPI | 1285369926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MOORE Owner 765-506-1839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-07-18 |