| NPI | 1497616601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA SHEPARD Billing Clerk 906-233-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 101YM0800X Counselor, Mental Health | |
| 133V00000X Dietitian, Registered | |
| 225X00000X Occupational Therapist | |
| 103K00000X Behavior Analyst | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 106S00000X Behavior Technician | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2026-02-11 |