NPI | 1659095503 |
---|---|
Entity Type | Organization |
Authorized Contact | CRYSTAL CLARK Np/Operating Agent 618-367-3732 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2022-10-03 |
Last Update Date | 2022-10-03 |