| NPI | 1578235123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE STOCKERT Director Of Health Services 866-918-2114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2021-12-09 |