| NPI | 1487683546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA A NELSON Credentialing COO Rdinator 906-233-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2018-03-17 |