| NPI | 1689393100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK D NANKIVELL Cto 877-400-0540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |