| NPI | 1659610608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK EVERETT JOHNSON Owner 231-487-2415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MI 6801089396) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2013-02-12 |