| NPI | 1710529508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE VELASQUEZ Owner 614-368-6311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-10-13 |
| Last Update Date | 2021-07-09 |