| NPI | 1700626629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE VERNON TUCKER Owner 949-390-4730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |