| NPI | 1639672108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA M LIEN LLC Sole Member 715-861-7762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 4017-125) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2023-05-04 |