| NPI | 1629563853 |
|---|---|
| Former Legal Business Name | DEREK L ROBERTS |
| Entity Type | Organization |
| Authorized Contact | DEREK ROBERTS Owner 316-201-6424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2018-06-29 |