| NPI | 1669125027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOMI TONY AMEDEDJI Manager 402-957-6694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-03-05 |