| NPI | 1477404085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EREA LONG Owner/Clinician 502-627-0377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-02-09 |