| NPI | 1437959376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JUDE Member 267-291-4385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103TC0700X Psychologist Clinical | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-05-21 |