| NPI | 1306604194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILIJHA-ESRAEL BASTIEN Executive Director/Mental Health C. 877-678-1774 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 225XM0800X Occupational Therapist Mental Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |