| NPI | 1457954554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEARISTEN GAINES Owner 330-540-3440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2023-02-21 |