| NPI | 1639768369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER NICOLE WILDER Clinical Professional Counselor 620-804-2942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-01-17 |
| Last Update Date | 2021-01-17 |