| NPI | 1497307045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY TRAVIS Owner 866-413-1988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2019-07-14 |
| Last Update Date | 2021-03-05 |