| NPI | 1629950357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA JEAN BACH Owner/Provider 984-215-0992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-07-23 |