| NPI | 1538917067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS SPELLS Cto 475-238-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-10 |