| NPI | 1518449602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE RUXTON Owner 515-508-9992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 071.007643) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-05 |