| NPI | 1366067076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN TOLBERT Owner 877-759-0919 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QC1800X Clinic/Center, Corporate Health |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-06-29 |