| NPI | 1497334189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS ETHERIDGE Therapist, Owner 667-706-9091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |