| NPI | 1427758481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM M STURDEVANT Clinical Director/Psychologist 920-888-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-03-08 |