| NPI | 1679390819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TRIPP Member 385-402-9015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2025-01-29 |