| NPI | 1598290074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI LYNN WIETHAN Owner/Psychotherapist 917-664-6530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2008033440) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |