| NPI | 1669250478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2024-09-17 |