| NPI | 1518646538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMEON MERTYL Director Of Operations 888-344-4549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-07-17 |