| NPI | 1386773463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA L PORTER Credentialing Manager 660-890-8156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2023-07-04 |