| NPI | 1407508419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY SUSAN HOGAN Behavior Analyst 267-815-1636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-20 |