| NPI | 1427787027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GAIL HALL Credentialing Agent 502-774-0671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-06-08 |