| NPI | 1467002543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEA KEPHART Executive Director 013-573-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2024-01-11 |