| NPI | 1659619310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE NEWMAN Owner 715-492-8652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 3195-123) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2013-05-15 |