| NPI | 1588393847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY CHRISTOPHER RYAN Director 424-272-0774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2022-06-09 |