| NPI | 1326745787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH INGERSON Dr 385-985-8423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2025-12-03 |