| NPI | 1679102230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MILLER Member 660-619-9315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2020-04-06 |