| NPI | 1336256213 |
|---|---|
| Other Name | CHILD & FAM SVC OTPT MH CL |
| Entity Type | Organization |
| Authorized Contact | JEANNE MADDOX Billing Manager 315-671-2959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-06-25 |