| NPI | 1710360169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW L HECK Partner 855-998-4376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 0810002923) |
| Additional Taxonomies | 251S00000X (Licence: VA 0904006775) |
| 251S00000X (Licence: VA 0810003933) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2019-02-22 |