| NPI | 1477416923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE ANN CLARK Mental Health Specialist 1 / Qmha R 541-310-1971 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-12-03 |
| Last Update Date | 2025-12-03 |