| NPI | 1457077448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMISTIC WILTZ Owner 346-327-4955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2024-04-05 |