| NPI | 1386277994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY L. MARSAW Pres/CEO 137-528-2328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 104100000X Social Worker |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |