| NPI | 1619530185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSIAH JAMES MILLER Owner & Clinical Training Director 872-808-0285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TH0004X Psychologist Health | |
| 103TH0100X Psychologist Health Service | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2023-02-27 |