| NPI | 1588332241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN MERVICH Owner 872-333-9282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 103TC0700X Psychologist Clinical | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-08-30 |