| NPI | 1326860628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR BOOMER-JENKS Owner 971-940-0387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-11-11 |