| NPI | 1629022330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABATHA L MASTERS Billing 937-734-4334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH 01-0503) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-08-25 |