| NPI | 1568823300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON PUNG Therapist 269-993-7672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801084659) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |