| NPI | 1508671462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN SCHULTE Owner 917-484-3517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-02-10 |