| NPI | 1356063739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK NEWSOME Biller/Credentialer 517-442-3341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-09-13 |