| NPI | 1528897121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER GRAY Owner 725-202-1022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-07-31 |