| NPI | 1619311537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL THEVAR President 267-718-5022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: PA 130030) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2022-08-17 |