| NPI | 1386355113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTALYN DAVIS Owner 888-823-4833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2022-12-13 |