| NPI | 1629670963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUINTEN LYNN Owner 775-300-0576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2022-06-22 |