| NPI | 1639946098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMAZ WELLINGTON Licensed Professional Counselor 262-297-6680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-06 |