| NPI | 1386388783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY BURKE CEO 000-000-0000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-04-22 |