| NPI | 1699530683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MOGA ROACH Owner 920-766-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-02-19 |