| NPI | 1699355149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA R RONCO Billing Manager 907-771-0536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-04-09 |