| NPI | 1649656273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN J HARDMAN Counselor 385-204-2135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 75857936004) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |