| NPI | 1588469761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA ROCHA Billing Manager 228-707-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-02-13 |