| NPI | 1427764836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA MARIE BURNS Pastoral Counselor 888-779-1232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 315P00000X Intermediate Care Facility, Mentally Retarded | |
| 106S00000X Behavior Technician | |
| 251S00000X Community/Behavioral Health | |
| 252Y00000X Early Intervention Provider Agency | |
| 305S00000X Point of Service | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-04-25 |