| NPI | 1295495992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANI MICHELLE GALLIMORE Certified Nurse Practitioner 937-369-3234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2021-12-21 |