| NPI | 1386101517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN JOHANSEN Authorized Member 754-837-1804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2025-04-12 |