| NPI | 1336867217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEE RINEHART Credentialing & Contracts Specialis 682-316-1856 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2024-11-21 |