| NPI | 1417754474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY LILLY Utilization Manager 304-408-3256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-02-27 |
| Last Update Date | 2025-02-27 |