| NPI | 1346899275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing 606-886-8572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2019-09-04 |