| NPI | 1366970535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL IRENE GARDNER Social Worker 385-325-0533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 9240433-3501) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |