| NPI | 1598321721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNETTE BOLTE Owner/Provider 288-596-5407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2021-01-16 |