| NPI | 1437859659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA CASTRO-MOCTEZUMA Program Director 712-560-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-07 |