| NPI | 1689281164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA C ANDERSON Member 269-420-8183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |