| NPI | 1669240156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS MOALLEM Therapist And Registrar Agent 779-537-2243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2023-12-14 |