| NPI | 1609352384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN MARMALICH Owner 228-200-0720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 25543) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C9311) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2018-08-30 |