| NPI | 1427770080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY FAYE SHEPARD Owner/Clinician 920-241-2865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-09-12 |