| NPI | 1346867603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD MICHAEL RAY Owner 315-400-5606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2020-07-02 |