| NPI | 1659105047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROGHAN COULSON Owner 517-795-0103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |