| NPI | 1396430682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN WOODALL Owner 702-604-7767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2023-04-11 |