| NPI | 1356096036 |
|---|---|
| Other Name | GROUP ID |
| Entity Type | Organization |
| Authorized Contact | CHERYL BOYLE Provider Network Managment Assoc 737-600-6039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2024-09-03 |