| NPI | 1578125969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA KELLEY-FREEMAN CEO 800-867-2395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QC1500X Clinic/Center Community Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2019-07-05 |