| NPI | 1326785361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SU BOUDREAU Owner 619-393-2290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-09-13 |