| NPI | 1619758836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TETYANA KOSTYSHYNA CEO 800-488-2604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |