| NPI | 1619530185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSIAH JAMES MILLER Owner 872-808-0285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TF0000X Psychologist, Family | |
| 103TH0004X Psychologist, Health | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103T00000X Psychologist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2026-02-06 |