| NPI | 1508302654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE HENNY Owner 689-710-3276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X (Licence: IA 079597) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2022-01-27 |