| NPI | 1497438428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WILSON President 267-999-9534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2025-08-14 |