| NPI | 1417434861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKENSY LEIGH ELLIS-WHITE Owner 765-893-1790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 180.009488) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2023-11-17 |