| NPI | 1326173360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W SLACK COO 800-854-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: PA 218750) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-03-06 |