| NPI | 1386262673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAVIS Owner 541-714-5123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2021-01-08 |