| NPI | 1508640814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA VAN GORDEN Owner 262-300-4948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-03-07 |