| NPI | 1568028140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN TANNER Owner 907-987-5088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-05-19 |
| Last Update Date | 2019-05-19 |