| NPI | 1558231639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAPREE SUMMERVILLE Owner 937-000-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-11-05 |
| Last Update Date | 2025-11-28 |