| NPI | 1538875125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK D BRAATZ Credentialing Specialist 844-646-3247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2025-06-26 |