| NPI | 1508696303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA 'SHURA' DAWN EAGEN Mental Health Counselor 458-215-1356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-08-06 |