| NPI | 1699342543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA BATES Owner 269-993-0112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 101YS0200X Counselor School | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-24 |