| NPI | 1548997513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVER MOORE CEO/President 267-804-1575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2022-08-01 |