| NPI | 1568239978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADISON HICKS Credentialing COO Rdinator 563-888-6282 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-06 |