| NPI | 1336910397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC NICCOLE Member 949-279-1165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-01-09 |