| NPI | 1407743321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DE VRIES Agent 641-895-8879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-08-02 |