| NPI | 1710113162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON T RALPH COO 800-434-4686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2018-11-29 |