| NPI | 1457576373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO A DE LOS ANGELES Medical Director 308-237-4739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |