| NPI | 1568069326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEFERTIA Y MASON Principal Therapist 502-416-8060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-05 |