| NPI | 1548490642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOYT ROBERSON Clinical Supervisor 877-929-9797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0122811) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |