| NPI | 1295310407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA E THIEMANN Billing & Credentialing Mnager 502-510-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-10 |