| NPI | 1629834015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREY KISSACK Mental Health Practicitioner 308-850-8862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |