| NPI | 1649131947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA TAMARA VASSELL Owner 800-735-8951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2025-11-18 |