| NPI | 1689338519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA ADRIAN Provider Enrollment 918-456-0641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2021-10-27 |