| NPI | 1457635583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY PULLEN Director 515-408-6218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001322) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001209) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-10-07 |