| NPI | 1457246589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI A ERATO Manager 262-201-0942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 1041C0700X Social Worker, Clinical | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-08-11 |