| NPI | 1639828361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN TUDSANDOS Business Manager 385-221-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2023-02-20 |