| NPI | 1528834124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATREVIOUS PERRY Owner 386-717-3468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 103K00000X Behavior Analyst | |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent | |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |