| NPI | 1619563004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W LESNIEWSKI Member 814-482-2209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-12-19 |
| Last Update Date | 2023-05-25 |