| NPI | 1316608441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WILCOX Director 541-900-8244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |