| NPI | 1699351874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT GORDON Owner 888-515-3834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2022-11-10 |