| NPI | 1588735930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY FUELLING Owner 660-429-6678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |