| NPI | 1538919410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA SOPHIA ELIZABETH CLAVIN Owner 188-851-6454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 251S00000X Community/Behavioral Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-01-17 |