| NPI | 1336762806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERYN WINSLOW Owner 386-795-4169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2020-05-20 |