| NPI | 1629575212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY RENEA KROMHOUT Co Owner 541-405-4622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2020-03-26 |