| NPI | 1407502842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LIEBENTHAL Former Manager 810-391-8921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2023-07-10 |