| NPI | 1336642958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALYN YOUNG Administrator 311-261-7785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: AZ BH5362) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2019-12-09 |