| NPI | 1376064311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASUKA CLARY Manager 857-496-5206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2020-01-02 |