| NPI | 1508640996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE PORTER Administrator 800-688-0388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 103TP0016X Psychologist Prescribing (Medical) |
| 163WM0705X Registered Nurse Medical-Surgical | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM2500X Clinic/Center Medical Specialty | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 282J00000X Religious Nonmedical Health Care Institution | |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 364SM0705X Clinical Nurse Specialist Medical-Surgical | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |