| NPI | 1700390374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY JANE KING CEO 920-728-1125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WI 6752-123) |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2017-11-18 |