| NPI | 1376250795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SHAW Clinical Social Worker 920-301-3546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-23 |