| NPI | 1528624756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARILYN NELSON Business Director 385-888-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-01-25 |