| NPI | 1689432270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY KILGORE MCDANIELS Executive Clinical Director 848-241-2959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2024-03-08 |