| NPI | 1518375963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE M. PING Owner 765-404-6411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2023-03-31 |