| NPI | 1538693668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK R KETTERING Owner 385-240-0321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8132472-6004) |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2017-04-15 |