| NPI | 1669184412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL HERNANDEZ Manager 725-301-1182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2024-07-31 |