| NPI | 1447621651 |
|---|---|
| Doing Business As | PROFESSIONAL BEHAVIORAL HEALTH MEDICINE |
| Entity Type | Organization |
| Authorized Contact | TANJA N ROTH Ap RN 785-633-9241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: KS 5374846112) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2023-05-16 |