| NPI | 1598479180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE KEYES Owner/Operator 267-265-2983 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |