| NPI | 1467007179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORIN A MENARD Owner 386-530-5158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2020-08-09 |