| NPI | 1639985237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA KERBY Owner 385-321-1149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2024-12-09 |