| NPI | 1639635931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA DESIREE CONAWAY Reimbursement Ops Manager 667-214-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-02-13 |