| NPI | 1427801059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHASTA HICKMAN Owner 971-303-9868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2025-08-13 |