| NPI | 1700599230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTREE LYNN THOMPSON Owner 971-915-9344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |