| NPI | 1568225001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAILOAH WILSON Psychiatric Nurse Practitioner 667-423-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-04-12 |