| NPI | 1508415175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LEA MIZER Owner Bcba 573-280-4559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2022-02-22 |