| NPI | 1538784848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA MISKIEWICZ Credentialing 316-519-1877 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2021-03-28 |