| NPI | 1700484755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER SULLIVAN Credentialing Specialist 269-547-9730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2020-10-13 |