| NPI | 1508319666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN DAWN MAYBERRY Therapist 712-527-1064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NE 10764) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |