| NPI | 1295097079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA REEVES Accounts Receivable And Billing Man 676-600-2249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-01-03 |