| NPI | 1306606132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIBERT JOHNSON Analyst 605-965-3149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-29 |