| NPI | 1396545547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA GREEN-BURNS Owner 800-985-9713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2026-05-31 |