| NPI | 1548072978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 833-759-8720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2025-01-22 |
| Last Update Date | 2025-07-16 |