| NPI | 1518697556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LYNN MILLER License Professional Counselor 181-450-4528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2022-06-13 |