| NPI | 1326127416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA NELSON Credentialing Specialist 906-233-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-01-11 |