| NPI | 1477362465 |
|---|---|
| Doing Business As | KETAMINESLC |
| Entity Type | Organization |
| Authorized Contact | NICOLAS SALOMON Director 385-474-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-01-03 |